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Traditional Risk Factors and Ischemic Stroke in Young Adults: The Baltimore-Washington Cooperative Young Stroke Study
Jennifer Rohr;
Steven Kittner, MD, MPH;
Barbara Feeser, MPH, MBA;
J. Richard Hebel, PhD;
Marsha-Gaye Whyte;
Alyse Weinstein, MA;
Norma Kanarak, PhD;
David Buchholz, MD;
Christopher Earley, MD, PhD;
Constance Johnson, MD;
Richard Macko, MD;
Thomas Price, MD;
Michael Sloan, MD;
Barney Stern, MD;
Robert Wityk, MD;
Marcella Wozniak, MD, PhD;
Roger Sherwin, MB, BChir
Arch Neurol. 1996;53(7):603-607.
Abstract
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Objective
To determine the association of hypertension, diabetes, and cigarette smoking with incidence of ischemic stroke in young adults.
Design
Case-control study.
Setting
Population-based sample of cases and controls.
Subjects
The study included 296 cases of incident ischemic stroke among black and white adults aged 18 to 44 years in central Maryland counties from the Baltimore-Washington Cooperative Young Stroke Study and 1220 black and white adults aged 18 to 44 years from the Maryland Behavioral Risk Factor Survey, a telephone survey of a random sample of the same region, to serve as controls.
Main Outcome Measures
Logistic regression models were developed to determine the age-adjusted odds ratios for each risk factor. Population-attributable risk percents were computed based on the odds ratios and prevalence of each risk factor.
Results
The age-adjusted odds ratios (95% confidence intervals) for white men (WM), white women (WW), black men (BM), and black women (BW) were as follows: current cigarette smoking: WM, 2.0 (1.1-3.8), WW, 2.1 (1.1-4.3), BM, 3.3 (1.6-6.6), and BW, 2.2 (1.3-3.9); history of diabetes mellitus: WM, 22.9 (5.8-89.6), WW, 6.2 (1.9-20.2), BM, 4.2 (0.8-21.9), and BW, 3.3 (1.4-7.7); and history of hypertension: WM, 1.6 (0.7-3.2), WW, 2.5 (1.1-5.9), BM, 3.8 (1.8-7.9), and BW, 4.2 (2.4-7.5). The population-attributable risk percents (95% confidence intervals) were as follows: current cigarette smoking: WM, 22.6 (3.1-38.2), WW, 17.2 (4.0-34.0), BM, 40.5 (23.1-54.0), and BW, 29.1 (13.5-41.9); history of diabetes mellitus: WM, 19.0 (8.2-28.5), WW, 15.8 (3.8-26.3), BM, 13.2 (5.3-20.4), and BW, 22.1 (12.5-30.7); and history of hypertension: WM, 21.7 (6.2-34.6), WW, 21.3 (5.4-34.5), BM, 53.5 (39.0-64.4), and BW, 50.5 (37.1-61.1).
Conclusions
Hypertension, diabetes mellitus, and current cigarette smoking are important risk factors in a biracial young adult population. Cigarette smoking and hypertension, the 2 most modifiable risk factors, were particularly important risk factors in young blacks.
Author Affiliations
From the Department of Neurology (Mss Rohr, Feeser, and Whyte, and Drs Kittner, Macko, Price, Sloan, and Wozniak) and the Department of Epidemiology and Preventive Medicine (Drs Kittner, Hebel, Price, Sloan, and Sherwin), University of Maryland Medical School, the Maryland State Department of Health and Mental Hygiene (Ms Weinstein and Dr Kanarak), the Department of Neurology (Drs Buchholz, Earley, Johnson, and Wityk), The Johns Hopkins Hospital, the Department of Neurology (Drs Earley and Johnson), The Johns Hopkins Bayview Medical Center, and the Division of Neurology (Drs Stern and Wityk), Sinai Hospital, Baltimore. Dr Stern is now at the Department of Neurology, Emory University, Atlanta, Ga.
Footnotes
Accepted for publication April 29, 1996.
This study was supported in part by a grant-in-aid from the American Heart Association, Dallas, Tex, and with funds contributed in part by the Maryland Affiliates Inc of the American Heart Association. Drs Kittner, Hebel, Price, Sloan, and Sherwin and Mss Rohr and Feeser were supported by a Clinical Stroke Research Center Award (NS16332-11) and Dr Wozniak by a Clinical Investigator Development Award (K08-NS01764-01Al) from the National Institute of Neurologic Disorders and Stroke, Bethesda, Md.
The authors acknowledge the assistance of the following individuals who have sponsored the Baltimore-Washington Cooperative Young Stroke Study at their institutions: Frank Anderson, MD, Clifford Andrew, MD, PhD, Christopher Bever, MD, Nicholas Buendia, MD, Remzi Demir, MD, John Eckholdt, MD, Nirmala Fernback, MD, Jerold Fleishman, MD, Benjamin Frishberg, MD, Stuart Goodinan, MD, PhD, Norman Hershkowitz, MD, PhD, Luke Kao, MD, PhD, Ramesh Khurana, MD, John Kurtzke, MD, William Leahy, MD, William Lightfoote II, MD, Michael Miller, MD, PhD, Harshad Mody, MBBS, Marvin Mordes, MD, Seth Morgan, MD, Howard Moses, MD, Mark Ozer, MD, Roger Packer, MD, Philip Pulaski, MD, Naghbushan Rao, MD, Solomon Robbins, MD, David Satinsky, MD, Michael Sellman, MD, PhD, Arthur Siebens, MD, Harold Stevens, MD, PhD, Dean Tippett, MD, Michael Weinrich, MD, Roger Weir, MD, Richard Weisman, MD, Don Wood, MD (deceased), and Mohammed Yaseen, MD.
In addition, the study could not have been completed without the support from the administration and medical records staffs at the following institutions: in Maryland, Anne Arundel Medical Center, Bon Secours Hospital, Calvert Memorial Hospital, Church Hospital Corporation, Doctors Community Hospital, Franklin Square Hospital Center, The Good Samaritan Hospital of Maryland Inc, Greater Baltimore Medical Center, Harbor Hospital Center, Holy Cross Hospital, Johns Hopkins Bayview Inc, The Johns Hopkins Hospital, Howard County General Hospital Inc, Laurel Regional Hospital, Liberty Medical Center Inc, Maryland General Hospital, Mercy Medical Center, Montebello Rehabilitation Hospital, Montgomery General Hospital, North Arundel Hospital, Northwest Hospital Center, Prince George's Hospital Center, Saint Agnes Hospital, Saint Joseph Hospital, Shady Grove Adventist Hospital, Sinai Hospital of Baltimore, Southern Maryland Hospital Center, Suburban Hospital, The Union Memorial Hospital, University of Maryland Medical System, Department of Veterans Affairs Medical Center in Baltimore, and Washington Adventist Hospital; and in Washington DC, Children's National Medical Center, District of Columbia General Hospital, The George Washington University Medical Center, Georgetown University Hospital, Greater Southeast Community Hospital, Hadley Memorial Hospital, Howard University Hospital, National Rehabilitation Hospital, Providence Hospital, Sibley Memorial Hospital, Veterans Affairs Medical Center, and The Washington Hospital Center.
Reprints: Steven Kittner, MD, Department of Neurology, University of Maryland Medical School, 655 W Baltimore St, Room 12-013, Baltimore, MD 21201-1559.
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