Abstract DP114: Racial Differences in the Associations of the Brain Care Score with Incident Stroke

Introduction: Stroke disproportionately affects Black individuals in the United States (U.S.). We aimed to investigate differences between Black and White individuals in the associations between health-related behaviors, measured with the Brain Care Score (BCS), and incident stroke. Methods: We analyzed data from the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort to evaluate the BCS, a tool encompassing 12 modifiable risk factors for age-related brain diseases (range: 0–21; higher scores indicate better brain care), in its association with incident stroke. Baseline BCS was compared between Black and White individuals using parametric tests. Cox proportional hazards models were stratified by race (Black vs. White) and adjusted for demographic and socioeconomic factors. Effect sizes were compared using Z-statistics. Results: We included 11,249 REGARDS participants with complete BCS data (30.8% Black, 57.3% female, mean age: 63.3 years). Black individuals had significantly lower mean baseline BCS compared to White individuals (13.8 [SD: 2.5] versus 14.7 [SD: 2.3], p < 0.001). During a median follow-up of 15.9 years, 696 strokes occurred (6.2% overall; and 6.2% in both Black [N=216] and White [N=480] participants). A five-point higher BCS was associated with 53% lower stroke risk in Black (Hazard Ratio [HR]: 0.47; 95% Confidence Interval [CI]: 0.36–0.62), versus 23% lower risk in White individuals (HR: 0.77; 95% CI: 0.62–0.95). The association between the BCS and incident stroke was significantly stronger among Black individuals compared to White individuals (Z-statistic; p = 0.0058). Conclusion: In this U.S. cohort that oversampled Black individuals, higher BCS was associated with lower incident stroke risk, with significantly stronger associations observed in Black compared with White participants. These findings suggest that BCS improvement may yield greater stroke prevention benefits in Black populations and help address disparities.