Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke: The strong heart study

Maria G. Karas, Richard B. Devereux, David O. Wiebers, Jack P. Whisnant, Lyle G. Best, Elisa T. Lee, Barbara V. Howard, Mary J. Roman, Jason G. Umans, Jorge Kizer

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: American Indians have high rates of stroke. Improved risk stratification could enhance prevention, but the ability of biochemical and echocardiographic markers of preclinical disease to improve stroke prediction is not well-defined. METHODS-: We evaluated such markers as predictors of ischemic stroke in a community-based cohort of American Indians without prevalent cardiovascular or renal disease. Laboratory markers included C-reactive protein, fibrinogen, urine albumin-to-creatinine ratio, and glycohemoglobin (HbA1c), whereas echocardiographic parameters comprised left atrial diameter, left ventricular mass, mitral annular calcification, and the ratio of early to late mitral diastolic velocities. Predictive performance was judged by indices of discrimination, reclassification, and calibration. RESULTS-: After adjustment for standard risk factors, only HbA1c, albuminuria, and left atrial diameter were significantly associated with first ischemic stroke. Addition of HbA1c, although not urine albumin-to-creatinine ratio, to a basic clinical model significantly improved the C-statistic (0.714 versus 0.695; P=0.044), whereas left atrial diameter modestly enhanced integrated discrimination improvement (0.90%; P=0.004), but not the C-statistic (0.701; P=0.528). When combined with HbA1c, left atrial diameter further increased integrated discrimination improvement (1.81%; P<0.001) but not the C-statistic (0.716). No marker achieved significant net reclassification improvement. CONCLUSIONS-: In this cohort at high cardiometabolic risk, HbA1c emerged as the foremost predictor of ischemic stroke when added to traditional risk factors, affording substantially improved discrimination, with a more modest contribution for left atrial diameter. These findings bolster the role of HbA1c in cardiovascular risk assessment among persons with glycometabolic disorders and provide impetus for further study of the incremental value of echocardiography in high-risk populations.

Original languageEnglish (US)
Pages (from-to)720-726
Number of pages7
JournalStroke
Volume43
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Stroke
North American Indians
Albumins
Creatinine
Biomarkers
Urine
Albuminuria
C-Reactive Protein
Fibrinogen
Calibration
Echocardiography
Kidney
Population

Keywords

  • biomarkers
  • echocardiography
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Karas, M. G., Devereux, R. B., Wiebers, D. O., Whisnant, J. P., Best, L. G., Lee, E. T., ... Kizer, J. (2012). Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke: The strong heart study. Stroke, 43(3), 720-726. https://doi.org/10.1161/STROKEAHA.111.631168

Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke : The strong heart study. / Karas, Maria G.; Devereux, Richard B.; Wiebers, David O.; Whisnant, Jack P.; Best, Lyle G.; Lee, Elisa T.; Howard, Barbara V.; Roman, Mary J.; Umans, Jason G.; Kizer, Jorge.

In: Stroke, Vol. 43, No. 3, 03.2012, p. 720-726.

Research output: Contribution to journalArticle

Karas, MG, Devereux, RB, Wiebers, DO, Whisnant, JP, Best, LG, Lee, ET, Howard, BV, Roman, MJ, Umans, JG & Kizer, J 2012, 'Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke: The strong heart study', Stroke, vol. 43, no. 3, pp. 720-726. https://doi.org/10.1161/STROKEAHA.111.631168
Karas, Maria G. ; Devereux, Richard B. ; Wiebers, David O. ; Whisnant, Jack P. ; Best, Lyle G. ; Lee, Elisa T. ; Howard, Barbara V. ; Roman, Mary J. ; Umans, Jason G. ; Kizer, Jorge. / Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke : The strong heart study. In: Stroke. 2012 ; Vol. 43, No. 3. pp. 720-726.
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T1 - Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke

T2 - The strong heart study

AU - Karas, Maria G.

AU - Devereux, Richard B.

AU - Wiebers, David O.

AU - Whisnant, Jack P.

AU - Best, Lyle G.

AU - Lee, Elisa T.

AU - Howard, Barbara V.

AU - Roman, Mary J.

AU - Umans, Jason G.

AU - Kizer, Jorge

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N2 - BACKGROUND AND PURPOSE-: American Indians have high rates of stroke. Improved risk stratification could enhance prevention, but the ability of biochemical and echocardiographic markers of preclinical disease to improve stroke prediction is not well-defined. METHODS-: We evaluated such markers as predictors of ischemic stroke in a community-based cohort of American Indians without prevalent cardiovascular or renal disease. Laboratory markers included C-reactive protein, fibrinogen, urine albumin-to-creatinine ratio, and glycohemoglobin (HbA1c), whereas echocardiographic parameters comprised left atrial diameter, left ventricular mass, mitral annular calcification, and the ratio of early to late mitral diastolic velocities. Predictive performance was judged by indices of discrimination, reclassification, and calibration. RESULTS-: After adjustment for standard risk factors, only HbA1c, albuminuria, and left atrial diameter were significantly associated with first ischemic stroke. Addition of HbA1c, although not urine albumin-to-creatinine ratio, to a basic clinical model significantly improved the C-statistic (0.714 versus 0.695; P=0.044), whereas left atrial diameter modestly enhanced integrated discrimination improvement (0.90%; P=0.004), but not the C-statistic (0.701; P=0.528). When combined with HbA1c, left atrial diameter further increased integrated discrimination improvement (1.81%; P<0.001) but not the C-statistic (0.716). No marker achieved significant net reclassification improvement. CONCLUSIONS-: In this cohort at high cardiometabolic risk, HbA1c emerged as the foremost predictor of ischemic stroke when added to traditional risk factors, affording substantially improved discrimination, with a more modest contribution for left atrial diameter. These findings bolster the role of HbA1c in cardiovascular risk assessment among persons with glycometabolic disorders and provide impetus for further study of the incremental value of echocardiography in high-risk populations.

AB - BACKGROUND AND PURPOSE-: American Indians have high rates of stroke. Improved risk stratification could enhance prevention, but the ability of biochemical and echocardiographic markers of preclinical disease to improve stroke prediction is not well-defined. METHODS-: We evaluated such markers as predictors of ischemic stroke in a community-based cohort of American Indians without prevalent cardiovascular or renal disease. Laboratory markers included C-reactive protein, fibrinogen, urine albumin-to-creatinine ratio, and glycohemoglobin (HbA1c), whereas echocardiographic parameters comprised left atrial diameter, left ventricular mass, mitral annular calcification, and the ratio of early to late mitral diastolic velocities. Predictive performance was judged by indices of discrimination, reclassification, and calibration. RESULTS-: After adjustment for standard risk factors, only HbA1c, albuminuria, and left atrial diameter were significantly associated with first ischemic stroke. Addition of HbA1c, although not urine albumin-to-creatinine ratio, to a basic clinical model significantly improved the C-statistic (0.714 versus 0.695; P=0.044), whereas left atrial diameter modestly enhanced integrated discrimination improvement (0.90%; P=0.004), but not the C-statistic (0.701; P=0.528). When combined with HbA1c, left atrial diameter further increased integrated discrimination improvement (1.81%; P<0.001) but not the C-statistic (0.716). No marker achieved significant net reclassification improvement. CONCLUSIONS-: In this cohort at high cardiometabolic risk, HbA1c emerged as the foremost predictor of ischemic stroke when added to traditional risk factors, affording substantially improved discrimination, with a more modest contribution for left atrial diameter. These findings bolster the role of HbA1c in cardiovascular risk assessment among persons with glycometabolic disorders and provide impetus for further study of the incremental value of echocardiography in high-risk populations.

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