title: Self-reported stroke symptoms without a prior diagnosis of stroke or transient ischemic attack: a powerful new risk factor for stroke.
abstract: OBJECTIVE
  Previously in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, we found 18% of the stroke/transient ischemic attack-free study population reported ≥1 stroke symptom at baseline. We sought to evaluate the additional impact of these stroke symptoms on risk for subsequent stroke.
  
  
  METHODS
  REGARDS recruited 30,239 US blacks and whites, aged 45+ years in 2003 to 2007 who are being followed every 6 months for events. All stroke events are physician-verified; those with prior diagnosed stroke or transient ischemic attack are excluded from this analysis. At baseline, participants were asked 6 questions regarding stroke symptoms. Measured stroke risk factors were components of the Framingham Stroke Risk Score.
  
  
  RESULTS
  After excluding those with prior stroke or missing data, there were 24,412 participants in this analysis with a median follow-up of 4.4 years. Participants were 39% black, 55% female, and had median age of 64 years. There were 381 physician-verified stroke events. The Framingham Stroke Risk Score explained 72.0% of stroke risk; individual components explained between 0.2% (left ventricular hypertrophy) and 5.7% (age+race) of stroke risk. After adjustment for Framingham Stroke Risk Score factors, stroke symptoms were significantly related to stroke risk: for each stroke symptom reported, the risk of stroke increased by 21% per symptom.
  
  
  CONCLUSIONS
  Among participants without self-reported stroke or transient ischemic attack, prior stroke symptoms are highly predictive of future stroke events. Compared with Framingham Stroke Risk Score factors, the impact of stroke symptom on the prediction of future stroke was almost as large as the impact of smoking and hypertension and larger than the impact of diabetes and heart disease.
authors.affiliation: Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA. dawn.kleindorfer@uc.edu
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Leslie
authors.initials: L
authors.lastname: McClure
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: David
authors.initials: D
authors.lastname: Rhodes
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000208:ethnology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology*; D044465:White People / Q000208:ethnology*