ArticleStroke2026
Late-Life Incident Stroke in the Atherosclerosis Risk in Communities Study: Etiology and Prediction.
Article in Stroke, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundAs life expectancy rises, identifying causes and risk factors for incident acute ischemic stroke (AIS) among the oldest-old (≥80 years) is increasingly important. We examined whether the effect of age at stroke on AIS subtype is mediated by embolic risk factors and whether these factors improve AIS prediction.
methodsStroke-free participants from the ARIC study (Atherosclerosis Risk in Communities) who developed AIS between visit 5 (2011-2013) and visit 10 (2023) were included for causal analysis; Stroke-free participants at visit 5 were included for prediction analysis. In logistics regression models, the association between age at stroke-onset (≥80 versus <80 years) and adjudicated AIS subtype (embolic ischemic stroke versus thrombotic ischemic stroke) was determined. Bootstrapped mediation analyses (1000-iterations) tested whether atrial fibrillation, myocardial infarction, coronary heart disease, heart failure, and electro/echocardiogram measures mediated the age-AIS subtype relationship. C statistics were calculated for AIS prediction (Predicting Risk of Cardiovascular Disease Events, CHA
resultsOf 6213 stroke-free participants at visit 5, 277 (4.4%) developed AIS during a median (Q1-Q3) of 5.1 (2.6-7.1) years (median [Q1-Q3] age: 76 [72-80] years; median [Q1-Q3] age at AIS: 81 [77-86] years; 62% female; 99 embolic ischemic stroke and 178 thrombotic ischemic stroke). Individuals with AIS ≥80 years had higher odds of embolic ischemic stroke (versus thrombotic ischemic stroke) compared with those aged <80 years (odds ratio, 1.90 [95% CI, 1.09-3.31]). The effect of age at stroke-onset on embolic ischemic stroke was mediated by atrial fibrillation (44%;
conclusionsThese findings suggest that identification and control of embolic risk factors are critical to reduce stroke risk as people age, and better stroke-specific prediction tools are needed.
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