Prediction of ischemic stroke risk in the atherosclerosis risk in communities study

Lloyd E. Chambless, Gerardo Heiss, Eyal Shahar, Mary Jo Earp, James Toole

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

The authors assessed the increase in the predictivity of ischemic stroke (IS) resulting from the addition of nontraditional risk factors and markers of subclinical disease to a basic model containing only traditional risk factors (current smoking, diabetes mellitus, systolic blood pressure, antihypertensive therapy, prior coronary disease, and left ventricular hypertrophy) among 14,685 middle-aged persons in the Atherosclerosis Risk in Communities Study. Participants were recruited from four US communities in 1987-1989. Risk prediction scores for IS through 2000 were estimated from Cox models. The ability to predict which persons would develop IS was assessed by means of the area under the receiver operating characteristic curve-the probability that persons with IS had a higher risk score than those without IS. Among 22 nontraditional factors considered, the joint addition of body mass index, waist:hip ratio, high density lipoprotein cholesterol, albumin, von Willebrand factor, alcohol consumption, peripheral arterial disease, and carotid artery wall thickness modestly and statistically significantly improved prediction of future IS over a risk score that included traditional factors. Further improvement was obtained by adding age and race. For women, the area under the receiver operating characteristic curve went from 0.79 to 0.83 to 0.84; for men, it went from 0.76 to 0.78 to 0.80. These modest improvements are not enough to influence clinical and public health efforts to reduce the community burden of IS.

Original languageEnglish (US)
Pages (from-to)259-269
Number of pages11
JournalAmerican Journal of Epidemiology
Volume160
Issue number3
DOIs
StatePublished - Aug 1 2004
Externally publishedYes

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Atherosclerosis
Stroke
ROC Curve
Blood Pressure
Aptitude
Waist-Hip Ratio
Peripheral Arterial Disease
von Willebrand Factor
Left Ventricular Hypertrophy
Carotid Arteries
Proportional Hazards Models
Alcohol Drinking
HDL Cholesterol
Antihypertensive Agents
Coronary Disease
Albumins
Diabetes Mellitus
Body Mass Index
Public Health
Joints

Keywords

  • Cerebrovascular accident
  • Risk factors
  • ROC curve

ASJC Scopus subject areas

  • Epidemiology

Cite this

Prediction of ischemic stroke risk in the atherosclerosis risk in communities study. / Chambless, Lloyd E.; Heiss, Gerardo; Shahar, Eyal; Earp, Mary Jo; Toole, James.

In: American Journal of Epidemiology, Vol. 160, No. 3, 01.08.2004, p. 259-269.

Research output: Contribution to journalArticle

Chambless, Lloyd E. ; Heiss, Gerardo ; Shahar, Eyal ; Earp, Mary Jo ; Toole, James. / Prediction of ischemic stroke risk in the atherosclerosis risk in communities study. In: American Journal of Epidemiology. 2004 ; Vol. 160, No. 3. pp. 259-269.
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