Abstract Body: Introduction:
Stroke is a leading cause of adult disability and the 5th leading cause of death in the United States. Both women and Black Americans have a higher lifetime risk of stroke. With stroke playing an important role in morbidity and mortality, there is a need for investigation of risk factors to aid in prevention. Type A behavior pattern (TABP) is characterized by certain behavioral tendencies and is categorized by time urgency/impatience (TUI) and achievement striving/competitiveness (ASC) components. Hypertension is a stroke risk factor and TABP is a risk factor for hypertension. Whether TABP is also a risk factor for stroke is unclear.

Objective and hypothesis:
We sought to estimate the risk of incident stroke among adults without prior stroke by the level of TABP. We hypothesized that TABP will be associated with greater stroke risk.

Methods:
REGARDS enrolled 30,239 White and non-Hispanic Black participants aged ≥45 years in 2003-2007. Participants were contacted every 6 months through structured phone calls, medical records were obtained, and possible stroke events were adjudicated by experts. TUI and ASC (TABP components) were assessed with the Framingham Type A scale at baseline. Those with prior strokes or missing TABP were excluded. Cox proportional hazard models estimated the adjusted relative hazard of stroke by level of TUI and ASC scores separately. Because of significant TUI*race and TUI*sex interactions on incident stroke, TUI was stratified by race and sex. There were no significant ASC*race or ASC*race interactions on incident stroke, so ASC was not stratified.

Results:
There were 16,982 participants with TUI responses and 16,606 participants with ASC responses; baseline demographics, follow-up, and stroke incidence were similar in both TUI and ASC groups (mean [SD] 64 [10] years old, 65% women, 60% White race, median follow-up 11 years; 5.1 strokes/1000 person-years). As shown in Figure, higher levels of TUI for Black participants and men were associated with greater adjusted stroke risk. Higher ASC levels were associated with greater adjusted stroke risk overall.

Conclusions:
Higher scores in the TUI component of TABP in Black participants and men and the ASC component of TABP in all were associated with greater stroke risk. Screening and aggressive management of stroke risk factors like hypertension that are also associated with TABP might attenuate some of the excess burden of stroke among persons with greater TABP.