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A health risk appraisal function has been developed for the prediction of stroke using the Framingham Study cohort. The stroke risk factors included in the profile are age, systolic blood pressure, the use of antihypertensive therapy, diabetes mellitus, cigarette smoking, prior cardiovascular disease (coronary heart disease, cardiac failure, or intermittent claudication), atrial fibrillation, and left ventricular hypertrophy by electrocardiogram. Based on 472 stroke events occurring during 10 years' follow-up from biennial examinations 9 and 14, stroke probabilities were computed using the Cox proportional hazards model for each sex based on a point system. On the basis of the risk factors in the profile, which can be readily determined on routine physical examination in a physician's office, stroke risk can be estimated. An individual's risk can be related to the average risk of stroke for persons of the same age and sex. The information that one's risk of stroke is several times higher than average may provide the impetus for risk factor modification. It may also help to identify persons at substantially increased stroke risk resulting from borderline levels of multiple risk factors such as those with mild or borderline hypertension and facilitate multifactorial risk factor modification. (Stroke 1991;22:312-318) S troke is the third leading cause of death in the United States and is a major source of disability in persons older than age 60 years. In the face of an elderly population of increasing size, stroke is likely to be responsible for even greater disability and death. Epidemiologic study has identified key risk factors for stroke and has provided an estimate of the relative impact of these factors. Using data collected over 36 years of follow-up in the general population sample at Framingham, Mass., a stroke risk profile or health risk appraisal function has been developed. This profile contains a number of ingredients not available at the time of the previous stroke risk handbook, which was based on 16 years of follow-up. 1 The inclusion of previously diagnosed cardiovascular disease (coronary heart disease Received October 15, 1990; accepted November 27, 1990. [includes history of myocardial infarction, angina pectoris, and coronary insufficiency], cardiac failure, and intermittent claudication), atrial fibrillation, and left ventricular hypertrophy by electrocardiogram as ingredients in the profile has improved the efficiency of the risk prediction and gives a more realistic assessment of the importance of the stroke risk factors. Key to the usefulness of determining the likelihood of stroke by means of a risk profile is evidence that modification of several potent risk factors will reduce stroke probability. Epidemiologic study and clinical trial results have shown that reduction of elevated blood pressure and cessation of cigarette smoking can reduce stroke incidence. Warfarin (and perhaps aspirin) therapy in persons with atrial fibrillation, reversal of left ventricular hypertrophy by electroca...

After multivariable adjustment, LA enlargement remained a significant predictor of stroke in men and death in both sexes. The relation of LA enlargement to stroke and death appears to be partially mediated by LV mass.

Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.

Background and Purpose We sought to modify existing sex-specific health risk appraisal functions (profile functions) for the prediction of first stroke that better assess the effects of the use of antihypertensive medication.Methods Health risk appraisal functions were previously developed from the Framingham Study cohort. These functions were Cox proportional hazards regression models relating age, systolic blood pressure, diabetes mellitus, cigarette smoking, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy by electrocardiogram, and the use of antihypertensive medication to the occurrence of stroke. Closer examination of the data indicated that antihypertensive therapy effect is present only for systolic blood pressures between 110 and 200 mm Hg. Adjustments to the regressions

High plasma homocysteine concentrations and low concentrations of folate and vitamin B6, through their role in homocysteine metabolism, are associated with an increased risk of extracranial carotid-artery stenosis in the elderly.

A standard analysis of the Framingham Heart Study data is a generalized person-years approach in which risk factors or covariates are measured every two years with a follow-up between these measurement times to observe the occurrence of events such as cardiovascular disease. Observations over multiple intervals are pooled into a single sample and a logistic regression is employed to relate the risk factors to the occurrence of the event. We show that this pooled logistic regression is close to the time dependent covariate Cox regression analysis. Numerical examples covering a variety of sample sizes and proportions of events display the closeness of this relationship in situations typical of the Framingham Study. A proof of the relationship and the necessary conditions are given in the Appendix.

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