Traditionally, stroke in children and young adults has been linked to diverse etiologies such as trauma, congenital heart disease, and autoimmune and hematologic diseases, while atherosclerotic risk factors have been considered unimportant. However, autopsy and carotid ultrasound studies suggest that atherosclerosis begins in childhood, and recent epidemiological studies suggest that atherosclerotic risk factors are increasingly prevalent among adolescents and young adults with stroke. Black race confers a similariy increased stroke risk in both children and adults, and the excess risk in black children does not appear to be fully explained by sickle cell disease. We hypothesize that stroke rates in the young have increased over the last 2 decades, and that race and atherosclerotic risk factors play a role in this increase.
The specific aims are:
Aim 1 : To develop a highly sensitive and specific algorithm for using electronic data to identify ischemic stroke and atherosclerotic risk factors (hypertension, hyperiipidemia, diabetes mellitus, obesity, smoking) in a cohort of children and adults in KPNC, and to validate this algorithm in a separate cohort within KPNC.
Aim 2 : In a large population-based cohort of children and young adults (
Understanding the relationship between atherosclerotic risk factors, race, socioeconomic status and stroke in the young is needed to address the full age spectrum of ethnic disparities in stroke risk. The results of this study may have an immediate clinical impact by indicating whether current guidelines for the primary prevention of stroke should be revised for eariier detection and treatment of atherosclerotic stroke risk factors.
|Mayeda, Elizabeth R; Glymour, M Maria; Quesenberry Jr, Charles P et al. (2017) Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups. Alzheimer Dis Assoc Disord 31:181-186|
|Fontil, Valy; Bibbins-Domingo, Kirsten; Nguyen, Oanh Kieu et al. (2017) Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices. Health Serv Res 52:807-825|
|Mayeda, Elizabeth R; Glymour, M Maria; Quesenberry, Charles P et al. (2017) Survival after dementia diagnosis in five racial/ethnic groups. Alzheimers Dement 13:761-769|
|Odden, Michelle C; Moran, Andrew E; Coxson, Pamela G et al. (2016) Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study. J Am Geriatr Soc 64:1015-23|
|Vasudeva, Eshan; Moise, Nathalie; Huang, Chen et al. (2016) Comparative Cost-Effectiveness of Hypertension Treatment in Non-Hispanic Blacks and Whites According to 2014 Guidelines: A Modeling Study. Am J Hypertens 29:1195-205|
|Fontil, Valy; Bibbins-Domingo, Kirsten; Kazi, Dhruv S et al. (2015) Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model. J Gen Intern Med 30:1147-55|
|Moran, Andrew E; Odden, Michelle C; Thanataveerat, Anusorn et al. (2015) Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med 372:447-55|
|Fontil, Valy; Gupta, Reena; Bibbins-Domingo, Kirsten (2015) Missed opportunities: young adults with hypertension and lifestyle counseling in clinical practice. J Gen Intern Med 30:536-8|
|Fontil, Valy; Pletcher, Mark J; Khanna, Raman et al. (2014) Physician underutilization of effective medications for resistant hypertension at office visits in the United States: NAMCS 2006-2010. J Gen Intern Med 29:468-76|