Risk Factors and Prediction of Stroke in a Population with High Prevalence of Diabetes: The Strong Heart Study
Year: 2017
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND OBJECTIVE: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value. METHODS AND RESULTS: A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods. RESULTS: Age, smoking status, alcohol consumption, waist circumference, hypertension status, an-tihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke. DISCUSSION: The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration. CONCLUSIONS: Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.
Institutions: University of Oklahoma Health Sciences Center, MedStar Health Research Institute, Weill Cornell Medicine, Texas Biomedical Research Institute, Missouri Breaks Industries Research (United States), Great Plains Tribal Chairmen’s Health Board, Albert Einstein College of Medicine, Mayo Clinic
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Awards: Cardiovascular Disease in Sioux Indians, G1188197595, The Strong Heart Study, Phase V, G164614106, CVD in American Indians Biomarker lab and Arizona Field Center, G1746001450, Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Strong Heart Family Study, G305513510, G3134865449, Cardiovascular Evaluation for the SHS Phase V, G3191277318, CVD in American Indians Genetics Center, G4289235060, CVD in American Indians Study and Data Management Center and OK Field Center, G4576555362, CVD in American Indians: Imaging and Cardiovascular Center, G709210845, CVD in American Indians The Dakota Field Center, G863538970, Cardiovascular Disease in Pima Indians, Oklahoma Shared Clinical and Translational Resources
OpenAlex ID: W2618074132