@article {9972, title = {Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity.}, journal = {JAMA Netw Open}, volume = {7}, year = {2024}, month = {2024 May 01}, pages = {e248502}, abstract = {

IMPORTANCE: Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown.

OBJECTIVE: To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years.

EXPOSURE: Time-dependent cumulative mean SBP.

MAIN OUTCOMES AND MEASURES: The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH.

RESULTS: Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0\% were women; 25.0\% were Black, 8.9\% were Hispanic of any race, and 66.2\% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95\% CI, 1.18-1.23]), IS (HR, 1.20 [95\% CI, 1.17-1.22]), and ICH (HR, 1.31 [95\% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95\% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95\% CI, 1.09-1.33]) and ICH (HR, 1.67 [95\% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95\% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.

}, keywords = {Adult, Aged, Black or African American, Blood Pressure, Cerebral Hemorrhage, Ethnicity, Female, Hispanic or Latino, Humans, Hypertension, Incidence, Ischemic Stroke, Longitudinal Studies, Male, Middle Aged, Racial Groups, Risk Factors, Stroke, Subarachnoid Hemorrhage, United States, White, White People}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2024.8502}, author = {Johnson, Kimson E and Li, Hanyu and Zhang, Min and Springer, Mellanie V and Galecki, Andrzej T and Whitney, Rachael T and Gottesman, Rebecca F and Hayward, Rodney A and Sidney, Stephen and Elkind, Mitchell S V and Longstreth, W T and Heckbert, Susan R and Gerber, Yariv and Sullivan, Kevin J and Levine, Deborah A} } @article {9616, title = {Trajectory of Cognitive Function After Incident Heart Failure.}, journal = {medRxiv}, year = {2024}, month = {2024 Feb 11}, abstract = {

BACKGROUND: The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition.

METHODS: This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a -score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition.

RESULTS: The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55\% female, 70.3\% White, 22.2\% Black 7.5\% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7\%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95\% CI -1.36, -0.80) and executive function (-0.65 points; 95\% CI -0.96, -0.34) but not memory (-0.51 points; 95\% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95\% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95\% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95\% CI -0.26, 0.04) compared with pre-HF slopes.

CONCLUSIONS: In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.

}, doi = {10.1101/2024.02.09.24302608}, author = {Shore, Supriya and Li, Hanyu and Zhang, Min and Whitney, Rachael and Gross, Alden L and Bhatt, Ankeet S and Nallamothu, Brahmajee K and Giordani, Bruno and Brice{\~n}o, Emily M and Sussman, Jeremy B and Gutierrez, Jose and Yaffe, Kristine and Griswold, Michael and Johansen, Michelle C and Lopez, Oscar L and Gottesman, Rebecca F and Sidney, Stephen and Heckbert, Susan R and Rundek, Tatjana and Hughes, Timothy M and Longstreth, William T and Levine, Deborah A} }