Abstract 19272: Risk Factors and Prediction of Stroke in a Population With High Prevalence of Diabetes: The Strong Heart Study
Introduction: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of African Americans or Whites in the U.S. The identification of risk factors and development of a model for risk prediction utilizing routinely collected variables would be of clinical and public health value for American Indians.
Methods: A total of 3,483 (2,044 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2008 for incident stroke. Overall, 302 stroke cases (183 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to assess effects of the risk factors/covariates on incident stroke, and develop stroke risk prediction models. Assessment of the developed stroke risk prediction models for discrimination and calibration were performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow (HL) statistic, respectively, and validated internally through use of Bootstrapping methods.
Results: Age, smoking status, alcohol consumption, hypertension status, antihypertensive therapy, diastolic blood pressures, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease or heart failure, and atrial fibrillation were identified as independent and significant risk factors for incident stroke in American Indians. The proposed prediction models produced a C=0.743 and HL=11.19 (p=0.191) for women, and a C=0.763 and HL=4.743 (p=0.785) for men, indicating good discrimination and calibration.
Conclusions: Our stroke risk prediction models provide a tool for stroke risk assessment in American Indians. The models may also be useful for identifying individuals at increased risk of incident stroke, and for designing prevention programs in American Indians and in other populations with a high prevalence of diabetes.
Author Disclosures: W. Wang: None. Y. Zhang: None. E.T. Lee: None. B.V. Howard: None. S.A. Cole: None. L.G. Best: None. T.K. Welty: None. E. Rhoades: None. J. Yeh: None. T. Ali: None. J.R. Kizer: Ownership Interest; Significant; Gilead Sciences, Inc; Pfizer, Inc. H. Kamel: None. N. Shara: None. D.O. Wiebers: None. R.B. Devereux: None.
- © 2016 by American Heart Association, Inc.