TY  - BOOK
AU  - Howard, Barbara V
AU  - Umans, Jason G
TI  - Incremental value of biochemical and echocardiographic measures in prediction of ischemic stroke: the Strong Heart Study
SN  - 0039-2499
KW  - *Brain Ischemia/me [Metabolism]
KW  - *Echocardiography/sn [Statistics & Numerical Data]
KW  - *Heart/ph [Physiology]
KW  - *Stroke/me [Metabolism]
KW  - Aged
KW  - Albuminuria/co [Complications]
KW  - Brain Ischemia/co [Complications]
KW  - Brain Ischemia/us [Ultrasonography]
KW  - C-Reactive Protein/an [Analysis]
KW  - Cardiovascular Diseases/co [Complications]
KW  - Cohort Studies
KW  - Creatinine/ur [Urine]
KW  - Data Interpretation, Statistical
KW  - Female
KW  - Fibrinogen/an [Analysis]
KW  - Follow-Up Studies
KW  - Heart Atria
KW  - Hemoglobin A, Glycosylated/an [Analysis]
KW  - Humans
KW  - Indians, North American
KW  - Kidney Diseases/co [Complications]
KW  - Male
KW  - Middle Aged
KW  - Risk Factors
KW  - Stroke/et [Etiology]
KW  - Stroke/us [Ultrasonography]
KW  - MedStar Health Research Institute
KW  - Journal Article
KW  - Research Support, N.I.H., Extramural
N1  - Available online from MWHC library: 1970 - present, Available in print through MWHC library: 1999 - 2006
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; 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; 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
UR  - http://dx.doi.org/10.1161/STROKEAHA.111.631168
ER  -