title: The inclusion of stroke in risk stratification for primary prevention of vascular events: the Northern Manhattan Study.
abstract: OBJECTIVE
  The Framingham coronary heart disease (CHD) risk score estimates 10-year risk of myocardial infarction (MI) and CHD death. Because preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate. We compared 10-year risk of (1) MI or CHD death; and (2) stroke, MI, or CHD death among individuals free of vascular disease.
  
  
  METHODS
  The Northern Manhattan Study contains a prospective, population-based study of stroke- and CHD-free individuals≥40 years of age followed for a median of 10 years for vascular events. Framingham coronary heart disease risk score was calculated for each individual and for each category of predicted risk, Kaplan-Meier observed 10-year cumulative probabilities were calculated for (1) MI or CHD death; and (2) stroke, MI, or CHD death. The cumulative probability of (1) was subtracted from (2), and 95% CIs for the difference were obtained with 1000 bootstrap samples. Using stratified analyses by race-ethnicity, we compared risk differences among race-ethnic groups.
  
  
  RESULTS
  Among 2613 participants (53% Hispanic, 25% non-Hispanic black, and 20% non-Hispanic white), observed 10-year risk of MI or CHD death was 14.20%. With stroke in the outcome, observed risk was 21.98% (absolute risk difference, 7.78%; 95% CI, 5.86% to 9.75%). The absolute risk difference among blacks was significantly larger than among whites (P=0.01).
  
  
  CONCLUSIONS
  In this multiethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% relative increase in estimated risk and crossing of the absolute risk threshold (>20% over 10 years) considered for preventive treatments such as statins.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, MPH, 1468 Madison Avenue, Annenberg 230B, New York, NY 10029, USA. mandip.dhamoon@mssm.edu
authors.forename: Mandip S
authors.initials: MS
authors.lastname: Dhamoon
authors.forename: Yeseon Park
authors.initials: YP
authors.lastname: Moon
authors.forename: Myunghee C
authors.initials: MC
authors.lastname: Paik
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D011322:Primary Prevention; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*