title: Differences in the role of black race and stroke risk factors for first vs. recurrent stroke.
abstract: OBJECTIVE
  To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs. recurrent stroke events.
  
  
  METHODS
  Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs. recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older.
  
  
  RESULTS
  Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86-3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70-1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke.
  
  
  CONCLUSIONS
  The association of age and black race differs substantially on first vs. recurrent stroke risk, with risk factors playing a similar role.
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL. ghoward@uab.edu.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: J David
authors.initials: JD
authors.lastname: Rhodes
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Moy
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Kara A
authors.initials: KA
authors.lastname: Sands
authors.affiliation: From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology*; D044465:White People