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Stroke Incidence and Smoking in American Indians: An Update from the Strong Heart Study

Friday, May 3, 2024

Presenting Author(s)

Taylor Niznik, BA BS

Medical Student
University of Oklahoma Health Sciences Center
Oklahoma City, OK, US

Co-Author(s)

TA

Tauqeer Ali, MD PhD

Professor of Research
Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
JD

Jason Deen, MD

Associate Professor
Department of Pediatrics and Medicine, University of Washington, Seattle, WA, United States
AF

Amanda Fretts, PhD

Associate Professor
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
Christopher S. Graffeo, MD MS

Assistant Professor of Neurosurgery
University of Oklahoma Health Sciences Center
Oklahoma City, OK, US
JR

Jessica Reese, PhD

Assistant Professor
Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
JU

Jason Umans, MD PhD

Associate Professor
Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States
YZ

Ying Zhang, MD PhD

Director, Center for American Indian Health Research & Presidential Associate Professor
Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States

Introduction: Compared to other populations, American Indians exhibit elevated rates of cigarette smoking, as well as increased stroke incidence and case-fatality rate. We report an update on the Strong Heart Study (SHS), exploring the relationship between smoking and long-term stroke epidemiology in this vulnerable population.

Methods: SHS is a longitudinal, population-based cohort study of cardiovascular disease in American Indian tribes and communities in Oklahoma, Arizona, and the Dakotas. We abstracted data from 5802 SHS participants without prevalent stroke who were enrolled in SHS during two asynchronous sampling periods, 1998-1999 for the original cohort and 2001-2003 for the family cohort. Shared frailty cox proportional hazards models were used to assess association of incident stroke with baseline smoking status, demographics, and other key risk factors including geographic site, SHS cohort, baseline alcohol consumption status, waist circumference, hypertension, diabetes mellitus (DM), HDL-C, and albuminuria.

Results: Among 5802 participants, baseline smoking status was positive in 2220 (38.3%). Incident stroke was observed in 456 (7.9%) during a median follow-up time of 30.2 years (range, 0.02-32.62). Participants with incident stroke were also baseline smokers 44.3% (n=202). Risk of incident stroke was 1.9-fold higher among baseline smokers as compared to non-smokers, after controlling for covariates (HR=1.9, 95%CI=1.54-2.30), although this also represented a marked decrease from the 2.4-fold increase in risk among SHS smokers reported in 2004.

Conclusion : Smoking remains a key risk factor for stroke in American Indians. The current study extends our prior research by widening the scope of analysis to include a broader range of participant ages, a more extended follow-up period in two cohorts of American Indians. Although preliminary evidence may indicate a favorable trend in the risk of incident stroke among baseline smokers, smoking cessation and on-going stroke surveillance remain a critical priority in the American Indian population.