Stroke and cognitive impairment remain a major public health problem with a disproportionate impact on blacks and Hispanics. The reasons for these race-ethnic disparities are not entirely clear. Improved detection and control of novel stroke risk factors are needed to reduce vascular disease burden. The Northern Manhattan prospective cohort consists of a population-based cohort of 3298 stroke-free adults enrolled since 2001 who have been followed annually for stroke, MI, and death. This collaborative study now involves faculty across 2 academic institutions and is the first prospective cohort study among whites, blacks and Caribbean Hispanics living in the same community. Over the last 5 years, the aims have expanded to include subclinical carotid, cardiac, and brain measures. High-resolution carotid imaging data has been assembled on 1770 subjects and a neuropsychological battery and standardized brain MRI will be completed on 1300 subjects with quantitative analyses to measure white matter hyperintensities, silent infarcts, and silent cerebral microbleeds. This grant supports continued follow-up and outcome detection and expansion of data collection in this cohort.
The aims are to evaluate the relationship between vascular outcomes (stroke, MI, and vascular death) and adiponectin, a new marker of obesity, new measures of subclinical carotid disease (carotid plaque area and densitometry), and quantitative MRI measures of vascular subclinical brain disease, as well as evaluate the impact on cognitive decline. To accomplish these aims, stored baseline plasma will be used to measure fasting adiponectin levels. High-resolution carotid imaging data will be quantitatively analyzed from standardized digital recordings. Repeat neuro-psychological testing emphasizing frontal-executive domains will be done on 1105 subjects. Subjects will be followed by annual telephone interviews to ascertain stroke, MI, death, and changes in cognitive state. In-person assessment will be done for all subjects who screen positive for any vascular event. Community stroke surveillance will be maintained to insure stroke detection among the cohort. The strengths of this cohort study are the wealth of baseline data already assembled, the tri-ethnic composition residing in the same community, the outstanding follow-up record, the evaluation of traditional and emerging risk factors, and the innovative assessment of MRI subclinical disease and carotid subclinical disease.

Public Health Relevance

Stroke and coronary heart disease comprise two of the top three leading causes of death in the US and are of increasing importance in developing countries. While heart disease is the leading cause of death, stroke is the leading cause of long-term disability. Stroke continues to have a disproportionate impact on mortality for blacks compared to whites. The aging and rapid growth of the black and Hispanic population has the potential to lead to future increases in the public health impact of stroke and vascular disease. The economic burden in the US due to stroke among Hispanics and blacks from 2005 to 2050 is projected to be $313 billion for Hispanics, and $379 billion for blacks. Race-ethnic disparities are driven by differences in stroke incidence and vascular risk factors and have remained significant even after accounting for differences in socioeconomic status. Healthy People 2010 called for an elimination of race-ethnic disparities, but did not provide a clear method to achieve this lofty goal. The principal goals of our study are to help fill the gaps in our knowledge of the epidemiology of stroke and vascular disease particularly among blacks and Hispanics in order to improve future prevention efforts. We have broadened our focus to investigate markers of obesity, subclinical disease measures of the carotid arteries and brain, and predictors of vascular cognitive impairment and decline. We need to understand the importance of these conditions in predicting stroke, MI, vascular death, and determining cognitive decline among minority populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Method to Extend Research in Time (MERIT) Award (R37)
Project #
4R37NS029993-21
Application #
8449344
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Moy, Claudia S
Project Start
1993-01-07
Project End
2015-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
21
Fiscal Year
2013
Total Cost
$1,692,571
Indirect Cost
$211,779
Name
University of Miami School of Medicine
Department
Neurology
Type
Schools of Medicine
DUNS #
052780918
City
Coral Gables
State
FL
Country
United States
Zip Code
33146
Della-Morte, David; Dong, Chuanhui; Markert, Matthew S et al. (2018) Carotid Intima-Media Thickness Is Associated With White Matter Hyperintensities: The Northern Manhattan Study. Stroke 49:304-311
Della-Morte, David; Gardener, Hannah; Dong, Chuanhui et al. (2018) Association Between Carotid Artery Function and Structure in the Northern Manhattan Study. Front Neurol 9:246
Nakanishi, Koki; Jin, Zhezhen; Homma, Shunichi et al. (2018) Association Between Heart Rate and Subclinical Cerebrovascular Disease in the Elderly. Stroke 49:319-324
Lorenz, Matthias W; Gao, Lu; Ziegelbauer, Kathrin et al. (2018) Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk - Results from the PROG-IMT collaboration. PLoS One 13:e0191172
Doliner, Brett; Dong, Chuanhui; Blanton, Susan H et al. (2018) Apolipoprotein E Gene Polymorphism and Subclinical Carotid Atherosclerosis: The Northern Manhattan Study. J Stroke Cerebrovasc Dis 27:645-652
Nakanishi, Koki; Jin, Zhezhen; Russo, Cesare et al. (2017) Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 24:392-398
Ezzati, Ali; Rundek, Tatjana; Verghese, Joe et al. (2017) Transcranial Doppler and Lower Extremity Function in Older Adults: Einstein Aging Study. J Am Geriatr Soc 65:2659-2664
Lorenz, Matthias W; Abdi, Negin Ashtiani; Scheckenbach, Frank et al. (2017) Automatic identification of variables in epidemiological datasets using logic regression. BMC Med Inform Decis Mak 17:40
Russo, Cesare; Jin, Zhezhen; Homma, Shunichi et al. (2017) LA Phasic Volumes and Reservoir Function in the Elderly by Real-Time 3D Echocardiography: Normal Values, Prognostic Significance, and Clinical Correlates. JACC Cardiovasc Imaging 10:976-985
Willey, Joshua; Gardener, Hannah; Cespedes, Sandino et al. (2017) Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multiethnic Urban Population: The Northern Manhattan Study. Stroke 48:2979-2983

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