Abstract 58: ASCVD Risk Score Trajectories During 25 Years Of Follow-up And Risk Of Ischemic Stroke And Cognitive Impairment

Background: An individual’s atherosclerotic burden is associated with the cumulative exposure to vascular risk factors across the lifespan. We used the ARIC study to identify trajectories of atherosclerotic cardiovascular disease (ASCVD) risk over time and to evaluate their association with risk of stroke and cognitive impairment. Methods: We included cardiovascular disease-free ARIC participants with low or borderline ASCVD risk at the baseline study visit (10-year ASCVD Risk Score <7.5%) and those who attended all 5 ARIC study visits (~25 years of follow-up). We used group-based trajectory modelling to define ASCVD trajectories. We report baseline characteristics of individuals in the four trajectories and the incidence of stroke (ischemic and hemorrhagic) and cognitive impairment (either MCI or dementia) during follow-up. Results: We included 3,470 ARIC participants. The four trajectories of ASCVD risk during follow-up are in Figure 1. The low and high increase trajectories comprised 46.5% and 7.0% of participants. Vascular risk factors such as hypertension, diabetes, hyperlipidemia, and obesity were more common in trajectories with higher ASCVD risk (Table 1). The rate of ARIC-adjudicated stroke during follow-up increased from 1.6% in the low trajectory to 4.6% in the high trajectory (p<0.001), of self-reported stroke from 8.6% to 16.6% (p<0.001), and of ARIC-adjudicated cognitive impairment from 16.0% to 35.0% (p<0.001). Conclusions: We found four main trajectories of ASCVD risk over 25 years of follow-up in individuals with baseline low or borderline ASCVD risk, which are associated with the risk of incident stroke and cognitive impairment. assessment.