{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:09:10Z","timestamp":1793214550573,"version":"4.5.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Existing stroke prediction models tend to overestimate contemporary stroke risk and inadequately incorporate neuroimaging parameters. This study aimed to develop a novel and accurate stroke prediction model for a community\u2010based population by integrating comprehensive neuroimaging data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">A prospective cohort study was conducted involving 1586 eligible participants from northern rural China. Baseline clinical and neuroimaging data were collected, with annual follow\u2010ups to assess incident stroke. Least absolute shrinkage and selection operator regression was used to identify key predictors, which were subsequently incorporated into a Cox proportional hazards model to develop the final predictive model. Internal validation was performed via 500 times bootstrap resampling. Model performance was evaluated using time\u2010dependent receiver operating characteristic curves, Brier scores, calibration plots, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">During a mean follow\u2010up of 8.0\u2009years, 54 incident strokes occurred among 1173 participants (4.6%). The final model incorporating least absolute shrinkage and selection operator\u2013selected predictors (current smoking, diabetes, high cerebral small\u2010vessel disease burden, and severe intracranial artery stenosis) showed strong discrimination, with area under the curve values of 0.88 (95% CI, 0.83\u20130.92) for 5\u2010year and 0.84 (95% CI, 0.79\u20130.90) for 7\u2010year prediction. Bootstrap validation confirmed model robustness (area under the curve values, 0.87 and 0.83, respectively). The model was well calibrated (Brier scores, 0.03 at 5\u2009years and 0.04 at 7\u2009years), and decision curve analysis indicated favorable net clinical benefit. A clinically applicable nomogram was developed for individualized risk assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The newly developed predictive model, combining clinical and neuroimaging features, provides accurate prediction of 5\u2010year and 7\u2010year stroke risk. Targeted management of diabetes, smoking, silent cerebral small\u2010vessel disease, and intracranial artery stenosis is essential for primary stroke prevention in community populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041413","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T05:22:30Z","timestamp":1755926550000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Development and Internal Validation of a Clinical Imaging\u2013Based Stroke Prediction Model in a Community Cohort"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5249-8769","authenticated-orcid":false,"given":"Yan\u2010Yan","family":"Wang","sequence":"first","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-752X","authenticated-orcid":false,"given":"Ding\u2010Ding","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei\u2010Fei","family":"Zhai","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3246-2301","authenticated-orcid":false,"given":"Zi\u2010Yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2641-5469","authenticated-orcid":false,"given":"Ning","family":"Su","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u2010Xin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7877-612X","authenticated-orcid":false,"given":"Jun","family":"Ni","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Yao","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u2010Ying","family":"Cui","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5211-1544","authenticated-orcid":false,"given":"Bin","family":"Peng","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8456-0686","authenticated-orcid":false,"given":"Ming\u2010Li","family":"Li","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6179-9632","authenticated-orcid":false,"given":"Zheng\u2010Yu","family":"Jin","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu\u2010Yang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2720-392X","authenticated-orcid":false,"given":"Fei","family":"Han","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8966-1379","authenticated-orcid":false,"given":"Yi\u2010Cheng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30499-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.1455"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.072"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.22.3.312"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.021275"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh189"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.586222"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.025553"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.532325"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2023.05.007"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.026"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.15187"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.016261"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0698"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11427-020-1849-x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14708"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2021-001102"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00131-X"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70124-8"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000837"},{"key":"e_1_3_2_22_2","first-page":"643","article-title":"A standardized method for measuring intracranial arterial stenosis","volume":"21","author":"Samuels OB","year":"2000","unstructured":"Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. Am J Neuroradiol. 2000;21:643\u2013646.","journal-title":"Am J Neuroradiol"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.020130"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2017.02110"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(95)00510-2"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(95)00048-8"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-071952"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2024.101019"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004064"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100464"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16057"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1159\/000508732"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030515"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000068408.82115.D2"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003183"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000010788"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004042"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-024-01797-2"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.5456"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000475"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.041413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:47:22Z","timestamp":1762930042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.041413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":39,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2025,9,2]]}},"alternative-id":["10.1161\/JAHA.125.041413"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.041413","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"2025-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e041413"}}