{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:07:44Z","timestamp":1792066064338,"version":"4.4.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Our analysis included 12\u2005813 participants with no prior head injury or stroke. The median follow-up time was 27.1 years (25th\u201375th percentile=21.1\u201330.5). Participants were of median age 54 years (25th\u201375th percentile=49\u201359) 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 time to ischemic stroke was 7.5 years (25th\u201375th percentile=2.2\u201314.0). In adjusted models, head injury was associated with an increased hazard of incident ischemic stroke (hazard ratio [HR], 1.34 [95% CI, 1.12\u20131.60]). We observed evidence of dose-response for the number of head injuries (1: HR, 1.16 [95% CI, 0.97\u20131.40]; \u22652: HR, 1.94 [95% CI, 1.39\u20132.71]) 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 \u22645: HR, 1.31 [95% CI, 1.04\u20131.64]; National Institutes of Health Stroke Scale score 6\u201310: HR, 1.64 [95% CI, 1.06\u20132.52]; National Institutes of Health Stroke Scale score \u226511: HR, 1.80 [95% CI, 1.18\u20132.76]). Results were similar across stroke mechanism and within strata of race, sex, and age.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.123.046443","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T09:00:37Z","timestamp":1715158837000},"page":"1562-1571","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Head Injury and Risk of Incident Ischemic Stroke in Community-Dwelling Adults"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1781-904X","authenticated-orcid":true,"given":"Holly","family":"Elser","sequence":"first","affiliation":[{"name":"Department of Neurology (H.E., L.W.P., R.D.-A., S.E.K., A.L.C.S.), University of Pennsylvania, Philadelphia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura W.","family":"Pappalardo","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.E., L.W.P., R.D.-A., S.E.K., A.L.C.S.), University of Pennsylvania, Philadelphia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9504-1256","authenticated-orcid":true,"given":"Rebecca F.","family":"Gottesman","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (R.F.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-0669","authenticated-orcid":true,"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C., S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6051-3594","authenticated-orcid":true,"given":"Ramon","family":"Diaz-Arrastia","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.E., L.W.P., R.D.-A., S.E.K., A.L.C.S.), University of Pennsylvania, Philadelphia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-1352","authenticated-orcid":true,"given":"Thomas H.","family":"Mosley","sequence":"additional","affiliation":[{"name":"The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson (T.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-6917","authenticated-orcid":true,"given":"Scott E.","family":"Kasner","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.E., L.W.P., R.D.-A., S.E.K., A.L.C.S.), University of Pennsylvania, Philadelphia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9327-7505","authenticated-orcid":true,"given":"Silvia","family":"Koton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C., S.K.)."},{"name":"School of Health Professions, Tel Aviv University, Israel (S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0026-5052","authenticated-orcid":true,"given":"Andrea L.C.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.E., L.W.P., R.D.-A., S.E.K., A.L.C.S.), University of Pennsylvania, Philadelphia."},{"name":"Department of Biostatistics, Epidemiology, and Informatics, School of Medicine (A.L.C.S.), University of Pennsylvania, Philadelphia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1808550"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012148"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.5024"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/2017.10.jns17352"},{"key":"e_1_3_3_6_2","unstructured":"Peterson AB Thomas KE Zhou H. 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