Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study.

D’Agostino, Ralph B.; Wolf, Philip A.; Belanger, Albert J.; Kannel, William B.

doi:10.1161/01.str.25.1.40

Cited by 630 publications

(578 citation statements)

References 2 publications

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“…Group‐based trajectory modeling has been used to identify outcome patterns for disability at the end of life36; frailty,39 depression,40 and hypertension41 in general populations; and short‐term depression in young survivors of breast cancer 42, 43. To the best of our knowledge, the current study is the first application of this statistical method to long‐term outcomes in older breast cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Mandelblatt

Clapp

Luta

et al. 2016

Cancer

138

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BACKGROUNDThe number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.METHODSA cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.RESULTSSurvivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.CONCLUSIONSTrajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society

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Section: Discussionmentioning

confidence: 99%

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Mandelblatt

Clapp

Luta

et al. 2016

Cancer

138

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“…Self‐report prevalent cardiovascular disease (CVD) with supporting evidence from available medical records included coronary heart disease, angina, or myocardial infarction (note, heart failure was a parent study exclusion). Framingham Stroke Risk Profile (FSRP) score applied points by sex for age, systolic blood pressure, antihypertensive medication usage, diabetes mellitus, current cigarette smoking, atrial fibrillation, LVH, and prevalent CVD 15. For this study, age was included in the statistical models as a separate covariate, and LV mass index was the predictor, so points assigned to age and LVH were removed from the FSRP score.…”

Section: Methodsmentioning

confidence: 99%

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Moore

Liu

Pechman

et al. 2018

JAHA

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BackgroundLeft ventricular (LV) hypertrophy is associated with cerebrovascular disease and cognitive decline. Increased LV mass index is a subclinical imaging marker that precedes overt LV hypertrophy. This study relates LV mass index to white matter microstructure and cognition among older adults with normal cognition and mild cognitive impairment.Methods and ResultsVanderbilt Memory & Aging Project participants free of clinical stroke, dementia, and heart failure (n=318, 73±7 years, 58% male, 39% mild cognitive impairment) underwent brain magnetic resonance imaging, cardiac magnetic resonance, and neuropsychological assessment. Voxelwise analyses related LV mass index (g/m2) to diffusion tensor imaging metrics. Models adjusted for age, sex, education, race/ethnicity, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E–ε4 status. Secondary analyses included a LV mass index×diagnosis interaction term with follow‐up models stratified by diagnosis. With identical covariates, linear regression models related LV mass index to neuropsychological performances. Increased LV mass index related to altered white matter microstructure (P<0.05). In models stratified by diagnosis, associations between LV mass index and diffusion tensor imaging were present among mild cognitive impairment participants only (P<0.05). LV mass index was related only to worse visuospatial memory performance (β=−0.003, P=0.036), an observation that would not withstand correction for multiple testing.ConclusionsIn the absence of prevalent heart failure and clinical stroke, increased LV mass index corresponds to altered white matter microstructure, particularly among older adults with clinical symptoms of prodromal dementia. Findings highlight the potential link between subclinical LV remodeling and cerebral white matter microstructure vulnerability.

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“…Sex was included in only 6% (1/16) of models predicting any outcome among patients with hemorrhagic stroke, as compared to 24% (6/25) of such models among ischemic stroke patients. Study‐ and model‐level characteristics of the 30 stroke‐related CPMs that included sex are presented in Table 2 25, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54…”

Section: Resultsmentioning

confidence: 99%

“…One so far unexplored implication of the dissemination of risk models into clinical practice is their potential to support appropriate sex‐specific care decisions in sexually dimorphic conditions such as stroke 22. While several commonly used CPMs for cardiovascular risk present sex‐stratified models or include sex in risk scores,23, 24, 25 the frequency and directionality of sex in the stroke‐related risk model literature have not been described.…”

Section: Introductionmentioning

confidence: 99%

Field Synopsis of the Role of Sex in Stroke Prediction Models

Paulus

Lai

Lundquist

et al. 2016

JAHA

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BackgroundGuidelines for stroke prevention recommend development of sex‐specific stroke risk scores. Incorporating sex in Clinical Prediction Models (CPMs) may support sex‐specific clinical decision making. To better understand their potential to guide sex‐specific care, we conducted a field synopsis of the role of sex in stroke‐related CPMs.Methods and ResultsWe identified stroke‐related CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Database, a systematic summary of cardiovascular CPMs published from January 1990 to May 2012. We report the proportion of models including the effect of sex on stroke incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 92 stroke‐related CPMs, 30 (33%) contained a coefficient for sex or presented sex‐stratified models. Only 12/58 (21%) CPMs predicting outcomes in patients included sex, compared to 18/30 (60%) models predicting first stroke (P<0.0001). Sex was most commonly included in models predicting stroke among a general population (69%). Female sex was consistently associated with reduced mortality after ischemic stroke (n=4) and higher risk of stroke from arrhythmias or coronary revascularization (n=5). Models predicting first stroke versus outcomes among patients with stroke (odds ratio=5.75, 95% CI 2.18–15.14, P<0.001) and those developed from larger versus smaller sample sizes (odds ratio=4.58, 95% CI 1.73–12.13, P=0.002) were significantly more likely to include sex.ConclusionsSex is included in a minority of published CPMs, but more frequently in models predicting incidence of first stroke. The importance of sex‐specific care may be especially well established for primary prevention.

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Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study.

Cited by 630 publications

References 2 publications

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Field Synopsis of the Role of Sex in Stroke Prediction Models

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