Henraya McGruder

Racial and Ethnic Disparities in Cardiovascular Risk Factors Among Stroke Survivors United States 1999 to 2001

Background and Purpose— Stroke mortality is higher among US blacks than it is among US whites. Few studies have examined racial and ethnic differences in the prevalence of cardiovascular disease (CVD) risk factors among stroke survivors, especially among Hispanics. Methods— Data are from 96 501 persons aged18 years or older who participated in the 1999, 2000, or 2001 National Health Interview Survey, a continuous annual household-based survey of the US population. Participants reported a history of stroke, hypertension, diabetes, myocardial infarction, and coronary heart disease. Other CVD risk factors were current smoking, overweight/obese, inadequate physical activity, and binge drinking. Results— Stroke was reported by 2.8% of blacks, 1.3% of Hispanics, and 2.2% of whites. Among 2265 stroke survivors, blacks were 1.65-times more likely (95% CI, 1.55 to 1.75) and Hispanics were 0.73-times less likely (95% CI, 0.69 to 0.78) than whites to report hypertension. Hispanics and blacks were more likely than whites to report diabetes (P < 0.05). Hispanics and blacks were less likely than whites to report total coronary heart disease (P < 0.05). Overweight was 1.63-times higher among blacks (95% CI, 1.55 to 1.73) and 1.36-times higher (95% CI, 1.30 to 1.44) among Hispanics than whites. Blacks were 1.82-times more likely (95% CI, 1.71 to 1.94) and Hispanics 2.09-times more likely (95% CI, 1.98 to 2.22) than whites to report inadequate levels of physical activity. Binge drinking and smoking were less common among Hispanics and Blacks than among whites (P < 0.05). Conclusions— Racial and ethnic disparities exist in stroke prevalence and CVD risk behaviors and medical history. Targeted secondary prevention will be important in reducing disparities among Hispanic and black stroke survivors.

Familial risk assessment for early-onset coronary heart disease

Purpose: We examined the performance of a familial risk assessment method that stratifies risk for early-onset coronary heart disease by considering the number of relatives with coronary disease, degree of relationship, lineage, and age at diagnosis.Methods: By using data from the HealthStyles 2003 survey, we assessed the associations between familial risk and early-onset coronary heart disease, diabetes, hypercholesterolemia, hypertension, and obesity. By using area under the curve statistics, we evaluated the discriminatory ability of various risk assessment models.Results: Of 4035 respondents, 60% were female and 72% were white, with a mean age of 48.8 years. After adjustment for demographics, strong and moderate risk were significantly associated with approximately a five- and twofold risk of early-onset coronary disease, respectively. After adjustment for demographics and personal history of cardiovascular disease, strong familial risk was also significantly associated with diabetes, hypercholesterolemia, hypertension, and obesity. A risk assessment model that included familial risk, demographics, and personal history of diabetes, hypercholesterolemia, hypertension, and obesity was most optimal with an area under the curve statistic of 87.2%Conclusions: Familial risk assessment can stratify risk for early-onset coronary heart disease. Several conditions associated with increased familial risk can be prevented. These results have important implications for risk assessment and risk-reducing interventions.

Expanding the definition of a positive family history for early-onset coronary heart disease

Purpose: Assessing familial risk for early-onset coronary heart disease (CHD) is typically limited to first-degree relatives with early-onset CHD. To evaluate the impact of additional family history, we examined the associations between various family history definitions and early-onset CHD.Methods: By using the national HealthStyles 2003 survey data, we assessed associations between self-reported family history and personal history of early-onset CHD (diagnosed at or before age 60 years), adjusting for demographics, hypercholesterolemia, hypertension, and obesity.Results: Of 4035 respondents, 60% were female and 72% were white, with a mean age of 48.8 years; 4.4% had early-onset CHD. In addition to having at least one first-degree relative with early-onset CHD, other significant associations included having at least one first-degree relative with late-onset CHD, at least one second-degree relative with early-onset CHD, and two or more affected second-degree relatives regardless of age of onset of CHD. Early-onset stroke in at least one first-degree relative and, in women, having at least one first-degree relative with diabetes were also significantly associated with early-onset CHD.Conclusions: Family history beyond early-onset CHD in first-degree relatives is significantly associated with prevalent CHD diagnosed at or before age 60 years.

Characteristics of an "Ill-Defined" Diagnosis for Stroke. Opportunities for Improvement

Background and Purpose— Rapid and accurate evaluation of stroke subtypes is crucial for optimal treatment and outcomes. This study assessed factors associated with the likelihood of an “ill-defined” diagnosis for stroke hospitalizations. Methods— We examined all hospital claims for stroke among Medicare beneficiaries aged ≥65 years in 2000. Stroke subtypes included hemorrhagic (International Classification of Diseases, Ninth Revision, Clinical Modification codes 430 to 432), ischemic (433 to 434), ill-defined (436 to 437), and late effects of cerebrovascular disease (438). Results— Among 445 452 hospital claims for stroke, 65.3% were ischemic, 20.9% were ill defined, 11.9% were hemorrhagic, and 1.9% were late effects of cerebrovascular disease. After controlling for age, women (odds ratio [OR],1.30; 95% CI, 1.28 to 1.32), blacks (OR, 1.31; 95% CI, 1.28 to 1.33), and Hispanics (OR, 1.27; 95% CI, 1.20 to 1.34) were more likely to receive a discharge diagnosis of ill defined compared with men and whites, respectively. Differences in age, sex, emergency room presentation, and evidence of diagnostic procedures accounted for some but not all racial disparities. In 14 states, ill-defined strokes constituted ≥25% of all stroke diagnoses. Conclusion— The high proportion of stroke patients who receive an ill-defined diagnosis on discharge suggests a continued need for improvements in early response and prompt evaluation of strokes. Findings of geographic, gender, and racial disparities in ill-defined stroke diagnosis warrant further investigation. Reimbursement practices and public health efforts that promote hospital stroke policies are critical to improve disease reporting as well as clinical outcomes.

Family History as a Risk Factor for Early-Onset Stroke/Transient Ischemic Attack among Adults in the United States

Background: Stroke is a major cause of morbidity and death in the United States. We tested the association between familial risk for stroke and prevalence of the disease among US adults and assessed the use of family history of stroke as a risk assessment tool for the disease. Methods: Using data from the 2005 HealthStyles survey (n = 4,819), we explored the association between familial stroke risk (stratified as high, moderate or low) and the prevalence of stroke and related health conditions. We evaluated the clinical validity (sensitivity, specificity) of family history of stroke as an indicator of stroke risk. Stroke and the related medical conditions were self-reported. Results: Independent of other risk factors, people with a high familial risk for stroke were 4 times more likely to have had a stroke (95% confidence interval, CI, 2.6–6.0) than people with moderate or low familial risk. They were also 1.3 times (95% CI 1.1–1.6) more likely to have high blood pressure and 1.5 times (95% CI 1.3–2.0) more likely to have congestive heart failure. The sensitivity and specificity of using family history alone, high blood pressure alone or both risk factors to estimate stroke risk were 52 and 83%, 53 and 74%, and 29 and 95%, respectively. Conclusions: Despite several limitations typical of self-reported surveys, we find that in this sample of US adults, family history of stroke was significantly associated with the risk for stroke and high blood pressure as well as related conditions. Family history of stroke, alone or combined with other risk factors, can be a useful tool in assessing stroke risk among US adults.