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Georgios Tsivgoulis,
Suzanne Judd,
Abraham J Letter,
Andrei V Alexandrov,
George Howard,
Fadi Nahab,
Frederick W Unverzagt,
Claudia Moy,
Virginia J Howard, Brett Kissela,
Virginia G Wadley
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ABSTRACT: OBJECTIVE: We sought to determine the relationship of greater adherence to Mediterranean diet (MeD) and likelihood of incident cognitive impairment (ICI) and evaluate the interaction of race and vascular risk factors. METHODS: A prospective, population-based, cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007, excluding participants with history of stroke, impaired cognitive status at baseline, and missing data on Food Frequency Questionnaires (FFQ), was evaluated. Adherence to a MeD (scored as 0-9) was computed from FFQ. Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener. RESULTS: ICI was identified in 1,248 (7%) out of 17,478 individuals fulfilling the inclusion criteria. Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio [lsqb]OR[rsqb] 0.89; 95% confidence interval [lsqb]CI[rsqb] 0.79-1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76-1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status. There was no interaction between race (p = 0.2928) and association of adherence to MeD with cognitive status. However, we identified a strong interaction of diabetes mellitus (p = 0.0134) on the relationship of adherence to MeD with ICI; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants (OR 0.81; 95% CI 0.70-0.94; p = 0.0066) but not in diabetic individuals (OR 1.27; 95% CI 0.95-1.71; p = 0.1063). CONCLUSIONS: Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders. This association was moderated by presence of diabetes mellitus.
Neurology 04/2013; 80(18):1684-1692. · 8.31 Impact Factor
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ABSTRACT: The purpose of this study was to examine the association between prolongation of QT interval corrected for heart rate (QTc) with incident stroke.
Unlike cardiovascular morbidity and mortality, little is known about the relationship between QTc and risk of stroke.
A total of 27,411 participants age 45 years and older without previous stroke from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study were included in this analysis. QTc was calculated using Framingham formula (QTc(Fram)). Stroke cases were identified and adjudicated during up to 8.2 years of follow-up (median, 5.1 years).
The risk of incident stroke in study participants with prolonged QTc(Fram) was almost 3 times the risk in those with normal QTc(Fram) (hazard ratio [HR] [95% confidence interval (CI)]: 2.88 [2.12 to 3.92], p < 0.0001). After adjustment for demographics (age, race, and sex), traditional stroke risk factors (antihypertensive medication use, systolic blood pressure, current smoking, diabetes, left ventricular hypertrophy, atrial fibrillation, and previous cardiovascular disease), warfarin use, aspirin use, QRS duration and use of QTc-prolonging drugs, the risk of stroke remained significantly high (HR [95% CI]: 1.67 [1.16 to 2.41], p = 0.0061) and was consistent across several subgroups of REGARDS study participants. Similar results were obtained when the risk of stroke was estimated per 1-SD increase in QTc(Fram), (HR [95% CI]: 1.12 [1.03 to 1.21], p = 0.0053 in multivariable-adjusted model) and when other QTc correction formulas including those of Hodge, Bazett, and Fridericia were used.
QTc prolongation is associated with a significantly increased risk of incident stroke independent of traditional stroke risk factors. Examining the risk of stroke associated with QTc-prolonging drugs may be warranted.
Journal of the American College of Cardiology 04/2012; 59(16):1460-7. · 14.16 Impact Factor
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Manjula Kurella Tamura,
Paul Muntner,
Virginia Wadley,
Mary Cushman,
Neil A Zakai,
Brian D Bradbury, Brett Kissela,
Fred Unverzagt,
George Howard,
David Warnock,
William McClellan
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ABSTRACT: Albuminuria and estimated glomerular filtration rate (eGFR) are each associated with increased risk of cognitive impairment, but their joint association is unknown.
Prospective cohort study.
A US national sample of 19,399 adults without cognitive impairment at baseline participating in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) Study.
Albuminuria was assessed using urine albumin-creatinine ratio (UACR) and GFR was estimated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation.
Incident cognitive impairment was defined as score ≤4 on the 6-Item Screener at the last follow-up visit.
During a mean follow-up of 3.8 ± 1.5 years, UACRs of 30-299 and ≥300 mg/g were associated independently with 31% and 57% higher risk of cognitive impairment, respectively, relative to individuals with UACR <10 mg/g. This finding was strongest for those with high eGFRs and attenuated at lower levels (P = 0.04 for trend). Relative to eGFR ≥60 mL/min/1.73 m(2), eGFR <60 mL/min/1.73 m(2) was not associated independently with cognitive impairment. However, after stratifying by UACR, eGFR <60 mL/min/1.73 m(2) was associated with a 30% higher risk of cognitive impairment in participants with UACR <10 mg/g, but not higher UACRs (P = 0.04 for trend).
Single measures of albuminuria and eGFR, screening test of cognition.
When eGFR was preserved, albuminuria was associated independently with incident cognitive impairment. When albuminuria was <10 mg/g, low eGFR was associated independently with cognitive impairment. Albuminuria and low eGFR are complementary, but not additive, risk factors for incident cognitive impairment.
American Journal of Kidney Diseases 08/2011; 58(5):756-63. · 5.43 Impact Factor
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ABSTRACT: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States.
A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments.
A total of 1,937 participants (8.1%) declined to an SIS score ≤4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment.
Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.
Annals of Neurology 03/2011; 70(2):229-36. · 11.09 Impact Factor
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ABSTRACT: Previous research has reported worse outcomes after stroke for women and for African Americans, but few prospective population-based studies have systematically examined demographic differences on long-term stroke outcomes. Race and gender differences in 1-year stroke outcomes were examined using an epidemiologically derived sample of first-time stroke survivors from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
Participants of REGARDS who reported a first-time stroke event during regular surveillance calls were interviewed by telephone and then completed an in-home evaluation approximately 1 year after the verified first-time stroke event (N=112). A primary family caregiver was also enrolled and interviewed for each stroke survivor. Measures from the in-home evaluation included previously validated stroke outcomes assessments of neurological deficits, functional impairments, and patient-reported effects of stroke in multiple domains. Results- African American stroke survivors were less likely to be living with their primary family caregivers than white participants. Analyses that controlled for age, education, and whether the stroke survivors lived with their primary family caregivers indicated that African Americans and women showed significantly greater deficits on multiple 1-year outcome measures compared to whites and men, respectively.
Among community-dwelling stroke survivors with family caregivers, women and African Americans are at heightened risk for poor long-term outcomes 1 year after first-time stroke events. Rehabilitation services and public health policies aimed at enhancing stroke recovery rates should address these disparities in poststroke outcomes.
Stroke 03/2011; 42(3):626-31. · 5.73 Impact Factor
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ABSTRACT: To measure the impact of stroke on quality of life (QOL), and analyze whether race, gender, age, income, or living alone moderated those changes, using prospective longitudinal methods.
Participants in the REasons for Geographic and Racial Differences in Stroke study without history of stroke completed baseline SF-12 Mental (MCS) and Physical Component Summary (PCS) measures and a depression scale. Measures were repeated (M = 1231 days later) by 136 participants after an incident medically documented stroke and by 136 demographically matched stroke-free controls.
Stroke participants showed significant worsening than controls in all three QOL measures. Controls also declined significantly in PCS. Standardized effect sizes for stroke versus control participants after adjusting for covariates were similar across the three measures and ranged from .366 to .465 standard deviation units. Stroke survivors who lived alone were at greater risk for increases in depressive symptoms.
Multiple declines in QOL occur after stroke, and social isolation heightens risk for increasing depression after stroke. Our prospective design and use of a population-based sample with matched controls suggests similar effects in both physical health and mental health QOL domains and offers unique strengths in understanding the impact of stroke on QOL.
Quality of Life Research 12/2010; 20(6):799-806. · 2.30 Impact Factor
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ABSTRACT: Statin use and type have been variably associated with impaired or improved cognitive performance.
To assess the association of statin use and type (lipophilic vs hydrophilic) and cognitive impairment.
Cross-sectional analysis of 24 595 participants (7191 statin users and 17 404 nonusers) age > or = 45 years, from a population-based national cohort study (Reasons for Geographic And Racial Differences in Stroke) enrolled between January 2003 and October 2008, with oversampling from the southeastern Stroke Belt and African Americans. Statin use and type were documented in participants' homes by a trained health professional. Cognitive performance was assessed with a prior validated instrument of global cognitive status (Six-Item Screener). Cognitive impairment was defined as a score of < 4.
Overall, an association of cognitive impairment and statin use was observed (8.6% of users vs 7.7% of nonusers had cognitive impairment, P = 0.014); but, after adjusting for variables known to be associated with cognition (age, gender, race, income, education level, and cardiovascular disease), the association was attenuated (odds ratio [OR]: 0.98, confidence interval [CI]: 0.87-1.10). No association was observed between statin type (lipophilic vs hydrophilic) and cognition (OR: 1.03, CI: 0.86-1.24), and there were no regional differences in cognitive impairment in statin users (8% in the Stroke Belt and 7.9% in other regions, P = 0.63).
Statin use and type were marginally associated with cognitive impairment. After adjusting for known variables that affect cognition, no association was observed. No regional differences were observed. This large study found no evidence to support an association between statins and cognitive performance.
Clinical Cardiology 05/2010; 33(5):280-8. · 2.15 Impact Factor
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ABSTRACT: Despite widespread dissemination of target values, achieving a blood pressure of <130/80 mmHg is challenging for many individuals with diabetes. The purpose of the present study was to examine temporal trends in blood pressure control in hypertensive individuals with diabetes as well as the potential for race, sex, and geographic disparities.
We analyzed baseline data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort study of 30,228 adults (58% European American and 42% African American), examining the causes of excess stroke mortality in the southeastern U.S. We calculated mean blood pressure and blood pressure control rates (proportion with blood pressure <130/80 mmHg) for 5,217 hypertensive diabetic participants by year of enrollment (2003-2007) using multivariable logistic regression models.
Only 43 and 30% of European American and African American diabetic hypertensive participants, respectively, demonstrated a target blood pressure of <130/80 mmHg (P < 0.001). However, a temporal trend of improved control was evident; the odds of having a blood pressure <130/80 mmHg among diabetic hypertensive participants of both races enrolled in 2007 (as compared with those enrolled in 2003) were approximately 50% greater (P < 0.001) in multivariate models.
These data suggest temporal improvements in blood pressure control in diabetes that may reflect broad dissemination of tighter blood pressure control targets and improving medication access. However, control rates remain low, and significant racial disparities persist among African Americans that may contribute to an increased risk for premature cardiovascular disease.
Diabetes care 04/2010; 33(4):798-803. · 8.09 Impact Factor
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ABSTRACT: Previous studies have suggested that African-American populations have a lower prevalence of Parkinson's disease (PD); however, because African-Americans are underrepresented in many cohorts, this relationship is poorly understood. We evaluated data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to describe potential racial differences in PD prevalence.
We identified subjects using PD medications from the REGARDS study, a national longitudinal cohort study of 30,000 persons over age 45 with approximately equal representation of African-Americans and Whites.
The prevalence of PD medication use across the cohort was 0.78% and was less among African-Americans (0.51%) than among Whites (0.97%; OR 1.90; 95% CI 1.31-2.74). There was an association of gender and PD medication use, with a prevalence of 0.61% in females and 0.97% in males (OR 1.57; 95% CI 1.13-2.18). There was no association with income, education level or geographic region of residence.
The lower rate of PD medication use among African-Americans supports the suspected lower prevalence of PD among African-Americans suggested by other studies. While racial differences in PD diagnosis and treatment may contribute to the differences we observed, comparable disparities have not been observed in the REGARDS cohort for other diagnoses. Further studies of the REGARDS cohort may lead to important insights into potential biological differences in PD among African-Americans and Whites.
Neuroepidemiology 11/2009; 33(4):329-34. · 2.31 Impact Factor
