Head Injury and Risk of Incident Ischemic Stroke in Community-Dwelling Adults

Holly Elser*, Laura W. Pappalardo, Rebecca F. Gottesman, Josef Coresh, Ramon Diaz-Arrastia, Thomas H. Mosley, Scott E. Kasner, Silvia Koton, Andrea L.C. Schneider

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: While stroke is a recognized short-term sequela of traumatic brain injury, evidence about long-term ischemic stroke risk after traumatic brain injury remains limited. METHODS: The Atherosclerosis Risk in Communities Study is an ongoing prospective cohort comprised of US community-dwelling adults enrolled in 1987 to 1989 followed through 2019. Head injury was defined using self-report and hospital-based diagnostic codes and was analyzed as a time-varying exposure. Incident ischemic stroke events were physician-adjudicated. We used Cox regression adjusted for sociodemographic and cardiovascular risk factors to estimate the hazard of ischemic stroke as a function of head injury. Secondary analyses explored the number and severity of head injuries; the mechanism and severity of incident ischemic stroke; and heterogeneity within subgroups defined by race, sex, and age. RESULTS: Our analysis included 12 813 participants with no prior head injury or stroke. The median follow-up age was 27.1 years (25th-75th percentile=21.1-30.5). Participants were of median age 54 years (25th-75th percentile=49-59) at baseline; 57.7% were female and 27.8% were Black. There were 2158 (16.8%) participants with at least 1 head injury and 1141 (8.9%) participants with an incident ischemic stroke during follow-up. For those with head injuries, the median age to ischemic stroke was 7.5 years (25th-75th percentile=2.2-14.0). In adjusted models, head injury was associated with an increased hazard of incident ischemic stroke (hazard ratio [HR], 1.34 [95% CI, 1.12-1.60]). We observed evidence of dose-response for the number of head injuries (1: HR, 1.16 [95% CI, 0.97-1.40]; ≥2: HR, 1.94 [95% CI, 1.39-2.71]) but not for injury severity. We observed evidence of stronger associations between head injury and more severe stroke (National Institutes of Health Stroke Scale score ≤5: HR, 1.31 [95% CI, 1.04-1.64]; National Institutes of Health Stroke Scale score 6-10: HR, 1.64 [95% CI, 1.06-2.52]; National Institutes of Health Stroke Scale score ≥11: HR, 1.80 [95% CI, 1.18-2.76]). Results were similar across stroke mechanism and within strata of race, sex, and age. CONCLUSIONS: In this community-based cohort, head injury was associated with subsequent ischemic stroke. These results suggest the importance of public health interventions aimed at preventing head injuries and primary stroke prevention among individuals with prior traumatic brain injuries.

Original languageEnglish
Pages (from-to)1562-1571
Number of pages10
JournalStroke
Volume55
Issue number6
DOIs
StatePublished - 1 Jun 2024

Funding

FundersFunder number
National Institutes of Health
National Institute on Deafness and Other Communication Disorders
National Institute on Aging
National Heart, Lung, and Blood Institute75N92022D00003, 75N92022D00004, 75N92022D00001, 75N92022D00002, 75N92022D00005
National Heart, Lung, and Blood Institute
National Institute of Neurological Disorders and StrokeR25NS065745, K23NS123340
National Institute of Neurological Disorders and Stroke

    Keywords

    • brain injuries, traumatic
    • craniocerebral trauma
    • heart disease risk factors
    • ischemic stroke
    • stroke

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