Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women

Maarten J G Leening; Nancy R Cook; Oscar H Franco; JoAnn E Manson; Kamakshi Lakshminarayan; Michael J LaMonte; Enrique C Leira; Jennifer G Robinson; Paul M Ridker; Nina P Paynter

doi:10.1161/JAHA.117.007514

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Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women

Journal article

Open access

Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women

Maarten J G Leening, Nancy R Cook, Oscar H Franco, JoAnn E Manson, Kamakshi Lakshminarayan, Michael J LaMonte, Enrique C Leira, Jennifer G Robinson, Paul M Ridker and Nina P Paynter

Journal of the American Heart Association, Vol.7(19), pp.e007514-e007514

10/02/2018

DOI: 10.1161/JAHA.117.007514

PMCID: PMC6404882

PMID: 30371339

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Abstract

Background Cardiovascular risk factors have differential effects on various manifestations of cardiovascular disease, but to date direct formal comparisons are scarce, have been conducted primarily in men, and include only traditional risk factors. Methods and Results Using data from the multi-ethnic Women's Health Initiative Observational Study, we used a case-cohort design to compare 1731 women with incident cardiovascular disease during follow-up to a cohort of 1914 women. The direction of effect of all 24 risk factors (including various apolipoproteins, hemoglobin A1 , high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and tissue plasminogen activator antigen) was concordant for coronary heart disease (CHD, defined as myocardial infarction and CHD death) and ischemic stroke; however, associations were generally stronger with CHD. Significant differences for multiple risk factors, including blood pressure, lipid levels, and measures of inflammation, were observed when comparing the effects on hemorrhagic stroke with those on ischemic outcomes. For instance, multivariable adjusted hazard ratios per standard deviation increase in non-high-density lipoprotein cholesterol were 1.16 (95% confidence interval, 1.06-1.28) for CHD, 0.97 (0.88-1.07) for ischemic stroke, and 0.76 (0.63-0.91) for hemorrhagic stroke ( P<0.05 for equal association). Model discrimination was better for models predicting CHD or ischemic stroke than for models predicting hemorrhagic stroke or a combined end point. Conclusions Cardiovascular risk factors have largely similar effects on incidence of CHD and ischemic stroke in women, although the magnitude of association varies. Determinants of ischemic and hemorrhagic stroke substantially differ, underscoring their distinct biology. Cardiovascular disease risk may be more accurately reflected when combined cardiovascular disease or cerebrovascular outcomes are broken down into different first manifestations, or when restricted to ischemic outcomes.

Coronary Disease - blood

Risk Assessment - methods

United States - epidemiology

Prognosis

Prospective Studies

Survival Rate - trends

Cardiovascular Diseases - ethnology

Follow-Up Studies

Humans

Middle Aged

Risk Factors

Coronary Disease - ethnology

Biomarkers - blood

Incidence

Brain Ischemia - blood

Ethnic Groups

Lipids - blood

Cardiovascular Diseases - blood

Aged

Brain Ischemia - ethnology

Details

Title: Subtitle: Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women
Creators: Maarten J G Leening - 4 Department of Cardiology Erasmus M-University Medical Center Rotterdam Rotterdam The Netherlands
Nancy R Cook - 2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
Oscar H Franco - 3 Department of Epidemiology Erasmus MC-University Medical Center Rotterdam Rotterdam The Netherlands
JoAnn E Manson - 2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
Kamakshi Lakshminarayan - 5 Division of Epidemiology and Community Health School of Public Health University of Minnesota MN
Michael J LaMonte - 6 Department of Epidemiology and Environmental Health School of Public Health and Health Professions State University of New York Buffalo NY
Enrique C Leira - 7 Division of Cerebrovascular Diseases Department of Neurology Carver College of Medicine University of Iowa IA
Jennifer G Robinson - 8 Departments of Epidemiology and Medicine College of Public Health University of Iowa IA
Paul M Ridker - 2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
Nina P Paynter - 2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.7(19), pp.e007514-e007514
DOI: 10.1161/JAHA.117.007514
PMID: 30371339
PMCID: PMC6404882
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Publisher: England
Language: English
Date published: 10/02/2018
Academic Unit: Neurology; Epidemiology; Iowa Neuroscience Institute; Neurosurgery; Internal Medicine
Record Identifier: 9983995136602771

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