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The Northern Manhattan Study

Mitchell S. V. Elkind, MD, MS; Pankajavalli Ramakrishnan, MD, PhD; Yeseon P. Moon, MS; Bernadette Boden-Albala, DrPH; Khin M. Liu, BS; Steve L. Spitalnik, MD; Tanja Rundek, MD, PhD; Ralph L. Sacco, MD, MS; Myunghee C. Paik, PhD

Arch Neurol. 2010;67(1):(doi:10.1001/archneurol.2009.271).

Objective  To determine the association between a composite measure of serological test results for common infections (Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2) and stroke risk in a prospective cohort study.

Design  Prospective cohort followed up longitudinally for median 8 years.

Setting  Northern Manhattan Study.

Patients  Randomly selected stroke-free participants from a multiethnic urban community.

Main Outcome Measure  Incident stroke and other vascular events.

Results  All 5 infectious serological results were available from baseline samples in 1625 participants (mean [SD] age, 68.4 [10.1] years; 64.9% women). Cox proportional hazards models were used to estimate associations of each positive serological test result with stroke. Individual parameter estimates were then combined into a weighted index of infectious burden and used to calculate hazard ratios and confidence intervals for association with risk of stroke and other outcomes, adjusted for risk factors. Each individual infection was positively, though not significantly, associated with stroke risk after adjusting for other risk factors. The infectious burden index was associated with an increased risk of all strokes (adjusted hazard ratio per standard deviation, 1.39; 95% confidence interval, 1.02-1.90) after adjusting for demographics and risk factors. Results were similar after excluding those with coronary disease (adjusted hazard ratio, 1.50; 95% confidence interval, 1.05-2.13) and adjusting for inflammatory biomarkers.

Conclusions  A quantitative weighted index of infectious burden was associated with risk of first stroke in this cohort. Future studies are needed to confirm these findings and to further define optimal measures of infectious burden as a stroke risk factor.

Author Affiliations: Departments of Neurology (Drs Elkind and Boden-Albala and Ms Moon) and Pathology and Cell Biology (Ms Liu and Dr Spitalnik), College of Physicians and Surgeons, and Department of Biostatistics, Joseph P. Mailman School of Public Health (Dr Paik), Columbia University, New York, New York; Department of Neurology, Massachusetts General Hospital, Boston (Dr Ramakrishnan); and Departments of Neurology (Drs Rundek and Sacco) and Epidemiology and Genetics (Dr Sacco), Miller School of Medicine, University of Miami, Miami, Florida.

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