Prestroke Vascular Pathology and the Risk of Recurrent Stroke and Poststroke Dementia

Abstract

Survival after stroke has improved over the past decades, thanks to thrombolytic therapy, specialized stroke units, and better secondary prevention.1,2 However, such improved survival may lead to more people having long-term hazards of stroke, such as recurrent stroke and dementia.3,4 These longterm risks after stroke are not well documented, nor are the factors that determine this risk. In this regard, risk factors that lead to the initial stroke may also predispose to clinical adverse events after stroke. Indeed, we previously showed that 27% of all deaths after stroke can be attributed to risk factors already present before stroke. 5 We now expand on that previous report by investigating recurrent stroke and poststroke dementia and how these are affected by prestroke risk factors. MethodsExtensive details on the Methods are presented in the online-only Data Supplement and are largely identical to a previous article.5 Briefly, this study was embedded within the population-based Rotterdam Study, 6 which totals 14,926 participants aged >45 years, who were repeatedly examined every 4 years. We selected 1243 participants who had an incident stroke between 1990 and 2012 and matched these to 4 participants without stroke with matching done on date of selection, age, sex, and visit to the same examination round, using an incidence density sampling. Participants were then followed up for the occurrence of stroke or dementia until January 1, 2012. In total, 1237 participants with stroke and 4928 stroke-free participants were eligible for the analyses with recurrent stroke and, respectively, 993 and 4363 for the dementia analyses ( Figure I and Table I in the online-only Data Supplement). ResultsRisk of recurrent stroke and dementia was highest in the shortterm, but even beyond the first year, the risk of recurrent stroke (incidence rate ratio, 3.16 [95% confidence interval, 2.59-3.85]) and dementia (incidence rate ratio, 1.73 [1.38-2.17]) remained increased. However, these differences were only statistically significant from years 1 to 5 (Figure).Participants with stroke had a worse cardiovascular profile than participants without stroke (Table I online-only Data Supplement). Main factors contributing to a recurrent Background and Purpose-Improved short-term survival after stroke has necessitated quantifying risk and risk factors of long-term sequelae after stroke (ie, recurrent stroke and dementia). This risk may be influenced by exposure to cardiovascular risk factors before the initial stroke. Within the population-based Rotterdam Study, we determined the long-term risk of recurrent stroke and dementia, and the proportion of recurrent strokes and poststroke dementia cases that are attributable to prestroke cardiovascular risk factors (ie, the population attributable risk). Methods-We followed up 1237 patients with first-ever stroke and 4928 stroke-free participants, matched on age, sex, examination round, and stroke date (index date), for the occurrence of stroke or dementia. We calculated incidence rates in...

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