Journal Article

Prediction of Ischemic Stroke Risk in the Atherosclerosis Risk in Communities Study

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

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 160, issue 3, pages 259-269
Published in print August 2004 | ISSN: 0002-9262
Published online August 2004 | e-ISSN: 1476-6256 | DOI:
Prediction of Ischemic Stroke Risk in the Atherosclerosis Risk in Communities Study

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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.

Keywords: cerebrovascular accident; risk factors; ROC curve; Abbreviations: ARIC, Atherosclerosis Risk in Communities; AUC, area under the ROC curve; CI, confidence interval; FEV1, forced expiratory volume in 1 second; HDL, high density lipoprotein; ROC, receiver operating characteristic.

Journal Article.  7713 words.  Illustrated.

Subjects: Public Health and Epidemiology

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