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Cardiovascular Health Index and Risk of Stroke

Kulshreshtha, Ambar (2013)
Dissertation (164 pages)
Committee Chair / Thesis Adviser: Vaccarino, Viola
Committee Members: McClellan, William ; Veledar, Emir ; Goyal, Abhinav ; Judd, Suzanne Elizabeth
Research Fields: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health
Keywords: Stroke; Cardiovascular Diseases; Biomarker; Family History
Program: Laney Graduate School, Epidemiology
Permanent url:


Stroke is a leading cause of death and disability in the United States, with an estimated 600,000 incident strokes annually. Despite the advent of promising treatments, prevention is still the best approach in reducing the burden of stroke. A healthy lifestyle and achieving low risk factor levels can reduce the risk of stroke by about 80%. The American Heart Association and American Stroke Association proposed a definition of cardiovascular health and developed a new public health metric, the "cardiovascular health index" (CVHI), which incorporates several traditional cardiovascular risk factors and lifestyle behaviors and can be evaluated over time. The concept emphasizes primordial prevention by defining goals for health factors and behaviors and is meant to be simple in order to facilitate dissemination and implementation in the community. The new cardiovascular health metric has not been specifically evaluated in relation to stroke risk. This dissertation aims at bridging the gaps in public health and clinical knowledge on the utility of the new cardiovascular health metric in relation to stroke prevention. It contributes novel insight on the utility of the new metric of cardiovascular health for stroke prediction, and the impact of family history, familial and environmental factors. Knowledge gained from this dissertation will be useful for implementation of public health and individualized approaches that would increase the prevalence of a better cardiovascular health profile for stroke prevention.

Table of Contents

CHAPTER 1: Background -- 1.1 Stroke: Magnitude of Problem -- 1.2 Definition and Types of Stroke -- 1.3 Pathophysiology of Stroke -- 1.4 Risk Factors for Stroke -- 1.5 Differences in Stroke Incidence -- 1.6 Primary Prevention of Stroke -- 1.7 Concepts of Health and Disease -- 1.8 Measuring Cardiovascular Health -- CHAPTER 2: Hypothesis and Rationale -- 2.1 Study-1 -- 2.2 Study-2 -- 2.3 Study-3 -- 2.4 Description of Study and Data Set - REGARDS -- 2.5 Description of Study and Data Set - Emory Twins Studies -- CHAPTER 3: Cardiovascular Health Index and Risk of Incident Stroke -- 3.1 Abstract -- 3.2 Introduction -- 3.3 Methods -- 3.4 Results -- 3.5 Discussion -- CHAPTER 4: Family History of Stroke and Cardiovascular Health Index -- 4.1 Abstract -- 4.2 Introduction -- 4.3 Methods -- 4.4 Results -- 4.5 Discussion -- CHAPTER 5: Cardiovascular Health Index and Carotid Intima Media Thickness in a Twins Study -- 5.1 Abstract -- 5.2 Introduction -- 5.3 Methods -- 5.4 Results -- 5.5 Discussion -- CHAPTER 6: Summary of Findings and Future Directions: -- 6.1 Summary -- 6.2 Future Directions -- References -- Tables and Figures --


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