@article {1504, title = {Aspirin use and incident stroke in the cardiovascular health study. CHS Collaborative Research Group.}, journal = {Stroke}, volume = {29}, year = {1998}, month = {1998 May}, pages = {887-94}, abstract = {

BACKGROUND AND PURPOSE: Randomized clinical trials testing aspirin in relatively low-risk, middle-aged people have consistently shown small increases in stroke associated with aspirin use. We analyzed the relationship between the regular use of aspirin and incident ischemic and hemorrhagic stroke among people aged 65 years or older participating in the Cardiovascular Health Study.

METHODS: We conducted a multivariate analysis of incident stroke rates in a prospectively assessed, observational cohort of 5011 elderly people followed for a mean of 4.2 years.

RESULTS: Participants had a mean age of 72 years, and 58\% were women. Twenty-three percent used aspirin frequently, and 17\% used aspirin infrequently at study entry. Frequent aspirin use was associated with an increased rate of ischemic stroke compared with nonusers (relative risk= 1.6; 95\% confidence interval [CI], 1.2 to 2.2; P=0.001). After adjustment for other stroke risk factors, women who used aspirin frequently or infrequently at study entry had a 1.8-fold (95\% CI, 1.2 to 2.8) and 1.6-fold (95\% CI, 0.9 to 3.0) increased risk of ischemic stroke, respectively (P<0.01, test for trend), compared with nonusers. In men, aspirin use was not statistically significantly associated with stroke risk. Findings were similar when aspirin use in the years before the incident stroke was used in the modeling. Aspirin use at entry was also associated with a 4-fold (95\% CI, 1.6 to 10.0) increase in risk of hemorrhagic stroke for both infrequent and frequent users of aspirin (P=0.003).

CONCLUSIONS: Aspirin use was associated with increased risks of ischemic stroke in women and hemorrhagic stroke overall in this elderly cohort, after adjustment for other stroke predictors. The possibility exists of confounding by reasons for aspirin use rather than cause and effect. Whether regular aspirin use increases stroke risk for elderly people without cardiovascular disease can only be determined by randomized clinical trials.

}, keywords = {Aged, Aspirin, Brain Ischemia, Cardiovascular Diseases, Cerebral Hemorrhage, Cerebrovascular Disorders, Cohort Studies, Cyclooxygenase Inhibitors, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Incidence, Male, Regression Analysis, Risk Factors, Sex Factors, Time Factors}, issn = {0039-2499}, author = {Kronmal, R A and Hart, R G and Manolio, T A and Talbert, R L and Beauchamp, N J and Newman, A} } @article {1521, title = {Stroke risk in an elderly population with atrial fibrillation.}, journal = {J Gen Intern Med}, volume = {14}, year = {1999}, month = {1999 Jan}, pages = {56-9}, abstract = {

Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke, but the absolute rate of stroke varies widely depending on coexistent vascular disease. We assessed the stroke rate and predictive value of two published schemes for stroke risk stratification in a population-derived cohort of 259 elderly people with nonvalvular AF followed for a median of 5.3 years. The rate of ischemic stroke was 2.8\% per year (95\% confidence interval [CI] 1.9, 3.9). Thirty-one percent were predicted to be at low risk, and their stroke rate was 1.7\% per year (95\% CI 0.6, 3.8). Many people with AF in this population-derived cohort had relatively low rates of stroke. Further studies to reliably stratify stroke risk in patients with AF are needed.

}, keywords = {Aged, Atrial Fibrillation, Cerebrovascular Disorders, Cohort Studies, Humans, Male, Poisson Distribution, Proportional Hazards Models, Risk Factors}, issn = {0884-8734}, author = {Feinberg, W M and Kronmal, R A and Newman, A B and Kraut, M A and Bovill, E G and Cooper, L and Hart, R G} } @article {1228, title = {Albuminuria and the risk of incident stroke and stroke types in older adults.}, journal = {Neurology}, volume = {75}, year = {2010}, month = {2010 Oct 12}, pages = {1343-50}, abstract = {

BACKGROUND: The kidney biomarker that best reflects risk of stroke is unknown. We sought to evaluate the association of stroke with 3 kidney biomarkers: albuminuria, cystatin C, and glomerular filtration rate.

METHODS: These 3 biomarkers were determined in 3,287 participants without history of stroke from the Cardiovascular Health Study, a longitudinal cohort study of men and women age 65 years and older from 4 US communities. The biomarkers were albuminuria ascertained using urinary albumin-to-creatinine ratio (UACR) from morning spot urine, creatinine-based estimated glomerular filtration rate (eGFR), and cystatin C. Outcomes were incident stroke (any, ischemic, or hemorrhagic) during follow-up between 1996 and 2006.

RESULTS: A total of 390 participants had an incident stroke: 81\% ischemic, 12\% hemorrhagic, and 7\% unclassified. In adjusted Cox regression models, UACR was more strongly related to any stroke, ischemic stroke, and hemorrhagic stroke than eGFR and cystatin C. The hazard ratio (HR) of any stroke comparing the top to bottom quintile of UACR was 2.10 (95\% confidence interval [CI] 1.47-3.00), while HR for eGFR was 1.29 (95\% CI 0.91-1.84) and for cystatin C was 1.22 (95\% CI 0.85-1.74). When considering clinically relevant categories, elevated UACR was associated with increased hazard of any stroke and ischemic stroke regardless of eGFR or cystatin C categories.

CONCLUSIONS: UACR was the kidney biomarker most strongly associated with risk of incident stroke. Results in this elderly cohort may not be applicable to younger populations. These findings suggest that measures of glomerular filtration and permeability have differential effects on stroke risk.

}, keywords = {Aged, Aged, 80 and over, Albuminuria, Community Health Services, Confidence Intervals, Female, Geriatric Assessment, Glomerular Filtration Rate, Humans, Incidence, Longitudinal Studies, Male, Proportional Hazards Models, Retrospective Studies, Risk Factors, Stroke}, issn = {1526-632X}, doi = {10.1212/WNL.0b013e3181f73638}, author = {Aguilar, M I and O{\textquoteright}Meara, E S and Seliger, S and Longstreth, W T and Hart, R G and Pergola, P E and Shlipak, M G and Katz, R and Sarnak, M J and Rifkin, D E} }