Role of Morbidity Clusters in Midlife on Ischemic Stroke Incidence and Severity: The ARIC Study.

IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY
Stroke Pub Date : 2025-10-01 Epub Date: 2025-09-04 DOI:10.1161/STROKEAHA.124.049496
Marco Egle, Renee C Groechel, Michelle C Johansen, Anna M Kucharska-Newton, Rebecca F Gottesman, Silvia Koton
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引用次数: 0

Abstract

Background: There is a strong association between vascular risk factors, particularly in midlife, and stroke risk; therefore, the co-occurrence of multiple risk factors may be especially informative. This study used a machine-learning-based cluster analysis to group individuals into clusters based on similar clinical profiles in midlife and assessed the clusters' associations with stroke risk and severity.

Methods: Participants (N=15 404) without prevalent stroke from the ARIC study (Atherosclerosis Risk in Communities) were included. An unsupervised agglomerative hierarchical clustering approach was used to allocate participants into clusters based on the presence of clinical risk factors in midlife: hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation, renal dysfunction, and peripheral artery disease. Clusters were then characterized by their defining features. In Cox proportional hazard models, the association of the clusters with overall stroke incidence (and with ischemic stroke incidence stratified by stroke severity) was tested. Multinomial logistic regression models were used to examine the association of morbidity clusters with outcomes of no stroke, stroke before the age of 70 years, and stroke at age of ≥70 years.

Results: Of 1424 incident ischemic strokes diagnosed from baseline (1987-1989) to December 31, 2020, 1104 included National Institutes of Health Stroke Scale (NIHSS) grading (minor-mild stroke: NIHSS score ≤5 [n=687]; moderate-severe stroke: NIHSS score >5 [n=417]). The cluster analysis identified 9 distinct clusters in the population with defining features: cluster 1 (relatively healthy); cluster 2 (smoking); cluster 3 (cancer); cluster 4 (peripheral artery disease); cluster 5 (obesity, diabetes, hypertension, and hypertriglyceridemia); cluster 6 (coronary heart disease); cluster 7 (atrial fibrillation); cluster 8 (heart failure); and cluster 9 (renal dysfunction). Compared with cluster 1, clusters 2 to 9 were each associated with a greater stroke risk, with the largest effect estimate for cluster 9 (hazard ratio, 3.00 [95% CI, 2.00-4.50]). The association with moderate-severe stroke incidence (versus no stroke) was also strongest for cluster 9 (hazard ratio, 4.78 [95% CI, 2.62-8.74]). Except for cluster 5 (which was associated with stroke at any age), all midlife morbidity clusters were associated with greater stroke risk before the age of 70 years but not after the age of 70 years.

Conclusions: The findings emphasize the importance of morbidity clusters in midlife for stroke incidence and severity.

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中年发病群对缺血性脑卒中发病率和严重程度的影响:ARIC研究。
背景:血管危险因素与中风风险之间有很强的关联,尤其是在中年;因此,多种危险因素的共同发生可能特别有用。本研究使用基于机器学习的聚类分析,根据中年人相似的临床特征将个体分组,并评估聚类与中风风险和严重程度的关联。方法:纳入ARIC研究(社区动脉粥样硬化风险)中无卒中流行的参与者(N= 15404)。采用无监督的聚类分层聚类方法,根据中年临床危险因素(高血压、糖尿病、冠心病、心力衰竭、心房颤动、肾功能不全和外周动脉疾病)的存在,将参与者分配到聚类中。然后用它们的定义特征来描述集群。在Cox比例风险模型中,检验了聚类与总体卒中发病率(以及按卒中严重程度分层的缺血性卒中发病率)的相关性。采用多项logistic回归模型检验发病率聚类与无卒中、70岁前卒中和≥70岁卒中结局的关系。结果:在基线(1987-1989)至2020年12月31日诊断的1424例缺血性卒中事件中,1104例纳入了美国国立卫生研究院卒中量表(NIHSS)分级(轻度-轻度卒中:NIHSS评分≤5 [n=687];中度-重度卒中:NIHSS评分>.5 [n=417])。聚类分析在人群中确定了9个不同的聚类,它们具有以下特征:聚类1(相对健康);第二组(吸烟);第3组(癌症);第4组(外周动脉疾病);第5类(肥胖、糖尿病、高血压和高甘油三酯血症);第6组(冠心病);第7组(心房颤动);第8组(心力衰竭);第九组(肾功能不全)。与第1类相比,第2类至第9类均与更高的卒中风险相关,第9类的影响最大(风险比为3.00 [95% CI, 2.00-4.50])。与中重度卒中发生率(相对于无卒中)的关联在第9类中也是最强的(风险比,4.78 [95% CI, 2.62-8.74])。除了第5类(与任何年龄的中风相关),所有的中年发病率类在70岁之前与更高的中风风险相关,而在70岁之后则没有。结论:研究结果强调了中年卒中发病率和严重程度的重要性。
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来源期刊
Stroke
Stroke 医学-临床神经学
CiteScore
13.40
自引率
6.00%
发文量
2021
审稿时长
3 months
期刊介绍: Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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