Separate prediction of intracerebral hemorrhage and ischemic stroke

Bart S. Ferket, Bob J H Van Kempen, Renske G. Wieberdink, Ewout W. Steyerberg, Peter J. Koudstaal, Albert Hofman, Eyal Shahar, Rebecca F. Gottesman, Wayne Rosamond, Jorge Kizer, Richard A. Kronmal, Bruce M. Psaty, W. T. Longstreth, Thomas Mosley, Aaron R. Folsom, M. G Myriam Hunink, M. Arfan Ikram

Research output: Contribution to journalArticle

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Abstract

Objectives: To develop and validate 10-year cumulative incidence functions of intracerebral hemorrhage (ICH) and ischemic stroke (IS). Methods: We used data on 27,493 participants from 3 population-based cohort studies: the Atherosclerosis Risk in Communities Study, median age 54 years, 45% male, median follow-up 20.7 years; the Rotterdam Study, median age 68 years, 38%male, median follow-up 14.3 years; and the Cardiovascular Health Study, median age 71 years, 41%male, median follow-up 12.8 years. Among these participants, 325 ICH events, 2,559 IS events, and 9,909 nonstroke deaths occurred. We developed 10-year cumulative incidence functions for ICH and IS using stratified Cox regression and competing risks analysis. Basic models including only established nonlaboratory risk factors were extended with diastolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, body mass index, waist-to-hip ratio, and glomerular filtration rate. The cumulative incidence functions' performances were cross-validated in each cohort separately by Harrell C-statistic and calibration plots. Results: High total cholesterol/high-density lipoprotein cholesterol ratio decreased the ICH rates but increased IS rates (p for difference across stroke types <0.001). For both the ICH and IS models, C statistics increased more by model extension in the Atherosclerosis Risk in Communities and Cardiovascular Health Study cohorts. Improvements in C statistics were reproduced by cross-validation. Models were well calibrated in all cohorts. Correlations between 10-year ICH and IS risks were moderate in each cohort. Conclusions: We developed and cross-validated cumulative incidence functions for separate prediction of 10-year ICH and IS risk. These functions can be useful to further specify an individual's stroke risk.

Original languageEnglish (US)
Pages (from-to)1804-1812
Number of pages9
JournalNeurology
Volume82
Issue number20
DOIs
StatePublished - May 20 2014

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Cerebral Hemorrhage
Stroke
Incidence
HDL Cholesterol
Atherosclerosis
Cohort Studies
Cholesterol
Blood Pressure
Prediction
Waist-Hip Ratio
Health
Glomerular Filtration Rate
Calibration
Body Mass Index
Cohort

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Ferket, B. S., Van Kempen, B. J. H., Wieberdink, R. G., Steyerberg, E. W., Koudstaal, P. J., Hofman, A., ... Ikram, M. A. (2014). Separate prediction of intracerebral hemorrhage and ischemic stroke. Neurology, 82(20), 1804-1812. https://doi.org/10.1212/WNL.0000000000000427

Separate prediction of intracerebral hemorrhage and ischemic stroke. / Ferket, Bart S.; Van Kempen, Bob J H; Wieberdink, Renske G.; Steyerberg, Ewout W.; Koudstaal, Peter J.; Hofman, Albert; Shahar, Eyal; Gottesman, Rebecca F.; Rosamond, Wayne; Kizer, Jorge; Kronmal, Richard A.; Psaty, Bruce M.; Longstreth, W. T.; Mosley, Thomas; Folsom, Aaron R.; Hunink, M. G Myriam; Ikram, M. Arfan.

In: Neurology, Vol. 82, No. 20, 20.05.2014, p. 1804-1812.

Research output: Contribution to journalArticle

Ferket, BS, Van Kempen, BJH, Wieberdink, RG, Steyerberg, EW, Koudstaal, PJ, Hofman, A, Shahar, E, Gottesman, RF, Rosamond, W, Kizer, J, Kronmal, RA, Psaty, BM, Longstreth, WT, Mosley, T, Folsom, AR, Hunink, MGM & Ikram, MA 2014, 'Separate prediction of intracerebral hemorrhage and ischemic stroke', Neurology, vol. 82, no. 20, pp. 1804-1812. https://doi.org/10.1212/WNL.0000000000000427
Ferket BS, Van Kempen BJH, Wieberdink RG, Steyerberg EW, Koudstaal PJ, Hofman A et al. Separate prediction of intracerebral hemorrhage and ischemic stroke. Neurology. 2014 May 20;82(20):1804-1812. https://doi.org/10.1212/WNL.0000000000000427
Ferket, Bart S. ; Van Kempen, Bob J H ; Wieberdink, Renske G. ; Steyerberg, Ewout W. ; Koudstaal, Peter J. ; Hofman, Albert ; Shahar, Eyal ; Gottesman, Rebecca F. ; Rosamond, Wayne ; Kizer, Jorge ; Kronmal, Richard A. ; Psaty, Bruce M. ; Longstreth, W. T. ; Mosley, Thomas ; Folsom, Aaron R. ; Hunink, M. G Myriam ; Ikram, M. Arfan. / Separate prediction of intracerebral hemorrhage and ischemic stroke. In: Neurology. 2014 ; Vol. 82, No. 20. pp. 1804-1812.
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T1 - Separate prediction of intracerebral hemorrhage and ischemic stroke

AU - Ferket, Bart S.

AU - Van Kempen, Bob J H

AU - Wieberdink, Renske G.

AU - Steyerberg, Ewout W.

AU - Koudstaal, Peter J.

AU - Hofman, Albert

AU - Shahar, Eyal

AU - Gottesman, Rebecca F.

AU - Rosamond, Wayne

AU - Kizer, Jorge

AU - Kronmal, Richard A.

AU - Psaty, Bruce M.

AU - Longstreth, W. T.

AU - Mosley, Thomas

AU - Folsom, Aaron R.

AU - Hunink, M. G Myriam

AU - Ikram, M. Arfan

PY - 2014/5/20

Y1 - 2014/5/20

N2 - Objectives: To develop and validate 10-year cumulative incidence functions of intracerebral hemorrhage (ICH) and ischemic stroke (IS). Methods: We used data on 27,493 participants from 3 population-based cohort studies: the Atherosclerosis Risk in Communities Study, median age 54 years, 45% male, median follow-up 20.7 years; the Rotterdam Study, median age 68 years, 38%male, median follow-up 14.3 years; and the Cardiovascular Health Study, median age 71 years, 41%male, median follow-up 12.8 years. Among these participants, 325 ICH events, 2,559 IS events, and 9,909 nonstroke deaths occurred. We developed 10-year cumulative incidence functions for ICH and IS using stratified Cox regression and competing risks analysis. Basic models including only established nonlaboratory risk factors were extended with diastolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, body mass index, waist-to-hip ratio, and glomerular filtration rate. The cumulative incidence functions' performances were cross-validated in each cohort separately by Harrell C-statistic and calibration plots. Results: High total cholesterol/high-density lipoprotein cholesterol ratio decreased the ICH rates but increased IS rates (p for difference across stroke types <0.001). For both the ICH and IS models, C statistics increased more by model extension in the Atherosclerosis Risk in Communities and Cardiovascular Health Study cohorts. Improvements in C statistics were reproduced by cross-validation. Models were well calibrated in all cohorts. Correlations between 10-year ICH and IS risks were moderate in each cohort. Conclusions: We developed and cross-validated cumulative incidence functions for separate prediction of 10-year ICH and IS risk. These functions can be useful to further specify an individual's stroke risk.

AB - Objectives: To develop and validate 10-year cumulative incidence functions of intracerebral hemorrhage (ICH) and ischemic stroke (IS). Methods: We used data on 27,493 participants from 3 population-based cohort studies: the Atherosclerosis Risk in Communities Study, median age 54 years, 45% male, median follow-up 20.7 years; the Rotterdam Study, median age 68 years, 38%male, median follow-up 14.3 years; and the Cardiovascular Health Study, median age 71 years, 41%male, median follow-up 12.8 years. Among these participants, 325 ICH events, 2,559 IS events, and 9,909 nonstroke deaths occurred. We developed 10-year cumulative incidence functions for ICH and IS using stratified Cox regression and competing risks analysis. Basic models including only established nonlaboratory risk factors were extended with diastolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, body mass index, waist-to-hip ratio, and glomerular filtration rate. The cumulative incidence functions' performances were cross-validated in each cohort separately by Harrell C-statistic and calibration plots. Results: High total cholesterol/high-density lipoprotein cholesterol ratio decreased the ICH rates but increased IS rates (p for difference across stroke types <0.001). For both the ICH and IS models, C statistics increased more by model extension in the Atherosclerosis Risk in Communities and Cardiovascular Health Study cohorts. Improvements in C statistics were reproduced by cross-validation. Models were well calibrated in all cohorts. Correlations between 10-year ICH and IS risks were moderate in each cohort. Conclusions: We developed and cross-validated cumulative incidence functions for separate prediction of 10-year ICH and IS risk. These functions can be useful to further specify an individual's stroke risk.

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