Five-year Cumulative Incidence Research Articles

Lymphadenopathy Syndrome in Homosexual Men

Seventy-five homosexual men with lymphadenopathy syndrome (LAS) for three months or more and antibody against the human immunodeficiency virus were enrolled in a prospective study in Atlanta in 1982 and 1983. Fourteen developed the acquired immunodeficiency syndrome (AIDS) three to 38 months after enrollment in the study and five to 56 months after onset of LAS. The five-year cumulative incidence rate of AIDS after onset of LAS was 29%; yearly incidence rates showed no decreasing trend with time. Of 18 patients with constitutional symptoms and a low T-helper cell count at their first visit, nine developed AIDS; of the remaining 57 patients, five developed AIDS (five-year cumulative incidence rates, 57% and 18%, respectively,<i>P</i>&lt;.001). Patients with lymphadenopathy syndrome are at continuing risk for the development of AIDS. Those with constitutional symptoms and a low T-helper cell count at their first visit appear to be at higher risk; other LAS patients are at lower risk but may still develop AIDS. (<i>JAMA</i>1987;257:335-337)

Noninvasive assessment of stroke risk in asymptomatic and nonhemispheric patients with suspected carotid disease. Five-year follow-up of 294 unoperated and 81 operated patients.

Based on the assumption that greater than or equal to 50% stenosis of the internal carotid artery increases stroke risk, noninvasive tests are being used to screen patients for prophylactic carotid endarterectomy. To assess the validity of this concept, 104 asymptomatic and 190 nonhemispheric patients referred for cerebrovascular tests were reviewed after 5 years. Carotid stenosis greater than or equal to 50% predicted a 15% stroke incidence at 2 years compared to a 3% incidence with 1-49% stenosis (p less than or equal to 0.05). Five-year cumulative stroke incidence was 21% with greater than 50% stenosis, 14% with 1-49% stenosis (NS), and 9% with 0% stenosis (p less than 0.05). Stenosis greater than or equal to 50% predicted increased cardiac mortality (p less than 0.025). Hypertensive patients, greater than 70 years, with greater than or equal to 50% stenosis had a 37% incidence of stroke; normotensive patients, less than 70 years, with or without stenosis, had few strokes. In patients with greater than or equal to 50% disease, surgery reduced the 5-year stroke rate from 21 to 8% (p less than 0.05), mitigated the effects of age and hypertension, and improved survival. Noninvasive test results must be considered in conjunction with age and hypertension in predicting stroke risk.