Association Between a Brain Care Score and Risk of Cerebrovascular Events in American Women
Leidys Gutierrez-Martinez1, Pamela M. Rist2, Julie E. Buring2, Martin Vandenburgh2, Christina Kourkoulis1, Jonathan Rosand1, Christopher Anderson3, Nirupama Yechoor1
1Department of Neurology, Massachusetts General Hospital, 2Department of Medicine, 3Department of Neurology, Brigham and Women’s Hospital
Objective:
To assess the association between a novel tool and incident cerebrovascular events (CVE).
Background:
The McCance Brain Care Score (MBCS) is a novel tool derived through a modified Delphi process to motivate lifestyle changes to reduce the risk of CVE based on prior studies. However, few studies have determined the association between the MBCS and incident CVE. Studying this potential association is important given the higher risk of stroke among women and the potential for unique risk profiles given physiologic and pharmacologic hormonal changes across the lifespan.
Design/Methods:
The study population was participants in the Women’s Health study (WHS) who had available risk factor information needed to calculate the modified MBCS 5 years after enrollment and no prior history of CVE. In the WHS-adaptation of the MBCS, higher scores suggest better brain health. Participants were followed from MBCS assessment until first CVE (Stroke or Transient Ischemic Attack), end of study, loss to follow-up, or death, whichever occurred first. CVE were confirmed by medical record review. Cox proportional hazards models were used to examine the association between the MBCS, modeled as a continuous variable, and incident CVE adjusted for potential confounders.
Results:
In total, 22,965 women were eligible with a median age of 58.0 (IQR 54.0-63.9) and median MBCS of 15 (14-17). There were 1,364 (5.9%) incident CVE events during a median follow-up of 22.5 (16.8-23.6) years. A one-point higher baseline MBCS was associated with 11% decreased risk of incident CVE after adjusting for age, postmenopausal status, and use of hormonal replacement therapy (HR=0.89; 95%CI=0.87-0.91). This association remained significant after adjusting for comorbidities, race, educational attainment, and income (HR=0.90; 95%CI=0.88-0.93).
Conclusions:
Higher baseline MBCS was associated with a decreased risk of incident CVE among women. Future studies are needed to understand how longitudinal changes in the MBCS impact risk of CVE.