Despite the reported decline in the incidence of stoke, there has not been a decline in stroke recurrence. Relatively little is known about whether ethnicity, independently or in conjunction with stroke risk factors, determines outcome after cerebral infarction. Most epidemiologic studies have been conducted predominately white populations. Less is known about black survivors of cerebral infarction, and few studies have been done in the growing Hispanic population. The study is designed to determine in whites, blacks and Hispanics the risk of stroke recurrence, myocardial infarction and death in 30 day survivors of cerebral infarction up to 10 years after an index event. Members of the cohort were admitted to the Neurological Institute of New York from 1983 to 1988. The majority are from Northern Manhattan, a community with many black and Hispanic residents. Columbia-Presbyterian Medical Center is the main provider of ambulatory and hospital care for this community. Risk factors for stroke, infarct subtype, adn findings on neurological examination and diagnostic studies, identified at the time of the initial cerebral infarction, have already been collected on the systematically evaluated cohort. Annual telephone follow-up of the patient or next of kin will be used to measure changes in risk factors and to identify those with stroke recurrence, symptomatic myocardial infarction or death. In-person follow-up interview and examination will be done on patients suspected of a subsequent event. Outcome after cerebral infarction will be analyzed by life table methods and Cox proportional hazards modelling. Stratification r the addition of other collected variables to the models are expected to show that the effect of ethnicity is not independent of other risk factors. Besides gaining new epidemiologic information on the risk and determinants of stoke recurrence, myocardial infarction and death after cerebral infarction in three ethnic groups, understanding the role of individual risk factors and their interactions with ethnicity will encourage more selective secondary prevention strategies.
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