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a Hebrew Hospital Home, Bronx, New York
b Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York
c Division of Clinical Epidemiology, University of Texas Medical School at Houston, Texas
Wilbert S. Aronow, CMD, Department of Medicine, New York Medical College, 23 Pebble Way, New Rochelle, NY 10804 E-mail: WSAronow{at}aol.com.
Decision Editor: John E. Morley, MB, BCh
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Abstract |
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Methods. The prevalence and incidence of ABI and the association of risk factors with new ABI were investigated in 201 Hispanic men, mean age 79 ± 8 years, and in 302 Hispanic women, mean age 80 ± 9 years, in a long-term health care facility. Mean follow-up was 42 ± 20 months in men and 47 ± 26 months in women.
Results. The prevalence of prior ABI was 33% in Hispanic men and 30% in Hispanic women. The incidence of new ABI was 24% in Hispanic men and 23% in Hispanic women. Significant independent risk factors for new ABI were age (risk ratio = 1.09 in men and 1.08 in women for each increase of 1 year of age), current cigarette smoking (risk ratio = 2.8 in men and 2.7 in women), hypertension (risk ratio = 2.8 in men), diabetes mellitus (risk ratio = 3.5 in men and 5.0 in women), prior ABI (risk ratio = 5.6 in men and 5.5 in women), serum total cholesterol (risk ratio = 1.03 in men and 1.01 in women for each 1 mg/dl increase), and serum high-density lipoprotein (HDL) cholesterol (risk ratio = 1.06 in men and 1.06 in women for each 1 mg/dl decrease).
Conclusions. Significant independent risk factors for new ABI were age, current cigarette smoking, diabetes mellitus, prior ABI, serum total cholesterol, and serum HDL cholesterol (inverse association) in older Hispanic men and women and hypertension in older Hispanic men.
ATHEROTHROMBOTIC brain infarction (ABI) is mainly a disease of the elderly (1). Risk factors for new ABI in either older men or women include male sex (1), prior ABI or transient cerebral ischemic attack (1)(2)(3), hypertension (1)(2)(3)(4)(5), diabetes mellitus (1)(3)(6), and cigarette smoking (1)(3)(7). The relationships between serum lipids and ABI (1)(3)(6)(8) and between obesity and ABI (1)(3)(6) are unclear.
There are limited data about risk factors for ABI in U.S. Hispanics, especially in Hispanics who are not Mexican Americans. We report data from a prospective study on risk factors for the incidence of new ABI in 503 older Hispanic men and women in a long-term health care facility in New York City.
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60 years in a long-term health care facility in New York City, 503 (14%) were Hispanics. The Hispanic population was from Puerto Rico and Central America. The 503 Hispanics included 201 men, mean age 79 ± 8 years (range 60 to 98), and 302 women, mean age 80 ± 9 years (range 60 to 98). The study population included unselected Hispanic persons 60 years of age and older who were not terminally ill at admission. The time frame of the study was from September 1, 1984, through December 31, 2000. The mean follow-up period was 42 ± 20 months (range 2 to 132) for men and 47 ± 26 months (range 1 to 196) for women. Prior ABI and new ABI were diagnosed by a neurologist as previously described (9). The focal neurological signs of ischemic stroke were explained by loss of function in a restricted area of the brain corresponding to a particular vascular territory (9). New ABI was also confirmed by computerized axial tomography in 115 of 118 persons (97%).
The risk factors evaluated were age, prior ABI, current cigarette smoking, systolic or diastolic hypertension, diabetes mellitus, obesity, serum total cholesterol, serum high-density lipoprotein (HDL) cholesterol, and serum triglycerides. Hypertension was diagnosed according to the criteria of the Sixth Joint National Committee (JNC VI) Report on the Detection, Evaluation, and Treatment of Hypertension (10). All persons with hypertension were treated with antihypertensive drug therapy. Diabetes mellitus was diagnosed according to the American Diabetes Association's new criteria (11). The weight and height of each person were correlated with the average height-weight table for persons aged 65 to 94 years (12). A person was considered obese if he or she was 20% above ideal body weight. Blood was drawn after a 14-hour overnight fast for determination of serum total and HDL cholesterol and triglycerides by Smith Kline Beecham Clinical Laboratories (Syosset, New York).
For analyses comparing the two groups, chi-square tests and Fisher exact tests were used for dichotomous variables and Student's t tests for continuous variables (Table 2 and Table 3 ). The relationship between prognostic variables measured at baseline and the time to the development of new ABI was analyzed using the stepwise Cox regression model (Table 4 and Table 5 ).
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Discussion |
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Significant independent risk factors for the development of ABI in older Hispanic men in the present study were age (risk ratio = 1.09 for each increment of 1 year of age), current cigarette smoking (risk ratio = 2.8), hypertension (risk ratio = 2.8), diabetes mellitus (risk ratio = 3.5), prior ABI (risk ratio = 5.6), serum total cholesterol (risk ratio = 1.03 for each 1 mg/dL increase), and serum HDL cholesterol (risk ratio = 1.06 for each 1 mg/dL decrease). Significant independent risk factors for the development of new ABI in older Hispanic women were age (risk ratio = 1.08 for each increment of 1 year of age), current cigarette smoking (risk ratio = 2.7), diabetes mellitus (risk ratio = 5.0), prior ABI (risk ratio = 5.5), serum total cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), and serum HDL cholesterol (risk ratio = 1.06 for each 1 mg/dl decrease.
Significant independent risk factors for the development of new ABI in 664 older men and in 1488 older women, predominantly white, were prior ABI (risk ratio = 2.6 in men and 2.9 in women), cigarette smoking (risk ratio = 1.9 in women), hypertension (risk ratio = 2.2 in men and 2.4 in women), diabetes mellitus (risk ratio = 1.5 in men and 1.5 in women), serum total cholesterol (risk ratio = 1.01 for each 1 mg/dL increase in women), and serum HDL cholesterol (risk ratio = 1.03 for each 1 mg/dl decrease in women).
Significant independent risk factors for the development of new ABI in 204 older African American men and in 462 older African American women were age (risk ratio = 1.03 for each increment of 1 year of age in women), prior ABI (risk ratio = 1.9 in men and 2.6 in women), cigarette smoking (risk ratio =2.8 in women), hypertension (risk ratio = 4.4 in men and 5.9 in women), diabetes mellitus (risk ratio = 2.9 in men and 3.5 in women), serum total cholesterol (risk ratio = 1.01 for each 1 mg/dl increase in women), and serum HDL cholesterol (risk ratio = 1.04 for each 1 mg/dl decrease in women).
The data from this study show that risk factor modification should be intensified in an older Hispanic population to reduce the incidence of new ABI. Cessation of cigarette smoking and treatment of hypertension, dyslipidemia, diabetes mellitus, and obesity should reduce the incidence of new ABI in older Hispanic men and women.
Received March 2, 2001
Accepted March 28, 2001
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