Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke

Amarenco, Pierre; Lavallée, Philippa C.; Tavares, Linsay Monteiro; Labreuche, Julien; Albers, Gregory W.; Abboud, Halim; Anticoli, Sabrina; Audebert, Heinrich J.; Bornstein, Natan M.; Caplan, Louis R.; Correia, Manuel; Donnan, Geoffrey A; Ferro, José M.; Góngora‐Rivera, Fernando; Heide, Wolfgang; Hennerici, Michael G.; Kelly, Peter; Král, Michal; Lin, Hsiu-Fen; Molina, Carlos A.; Park, Jong‐Moo; Purroy, Francisco; Rothwell, Peter M.; Segura, Tomás; Školoudík, David; Steg, Philippe Gabríel; Touboul, Pierre‐Jean; Uchiyama, Shinichiro; Vicaut, Éric; Wang, Yongjun; Wong, Ka Sing; Investigators, TIAregistry.org

doi:10.1056/nejmoa1802712

Cited by 280 publications

(276 citation statements)

References 16 publications

Supporting

Mentioning

231

Contrasting

Unclassified

Order By: Relevance

“…15 Recent studies adjusting for competing risk of death have reported 1-and 5-year incidences of recurrence of 3.6%-7.7% and 10.1%-16.8%. [16][17][18][19] Our results are thus supporting newer data from several other populations.…”

Section: Discussion/con Clus Ionsupporting

confidence: 87%

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

et al. 2019

View full text Add to dashboard Cite

Background and purpose Recurrent ischemic stroke (IS) or TIA is frequent with a considerable variation in incidence and mortality across populations. Current data on stroke recurrence and mortality are useful to examine trends, risk factors, and treatment effects. In this study, we calculated the incidence of recurrent IS or TIA in a hospital‐based stroke population in Western Norway, investigated recurrence factors, and estimated the effect of recurrence on all‐cause mortality. Methods This prospective cohort study registered recurrence and mortality among 1872 IS and TIA survivors admitted to the stroke unit at Haukeland University Hospital between July 2007 and December 2013. Recurrence and death until September 1, 2016, were identified by medical chart review. Cumulative incidences of recurrence were estimated with a competing risks Cox model. Multivariate Cox models were used to examine recurrence factors and mortality. Results During follow‐up, 220 patients had 277 recurrent IS or TIAs. The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% at the end of follow‐up. Hypertension (HR = 1.65, 95% CI 1.21‐2.25), prior symptomatic stroke (HR = 1.63, 95% CI 1.18‐2.24), chronic infarcts on MRI (HR = 1.48, 95% CI 1.10‐1.99), and age (HR 1.02/year, 95% CI 1.00‐1.03) were independently associated with recurrence. A total of 668 (35.7%) patients died during follow‐up. Recurrence significantly increased the all‐cause mortality (HR = 2.55, 95% CI 2.04‐3.18). Conclusions The risk of recurrent IS stroke or TIA was modest in our population and was associated with previously established risk factors. Recurrence more than doubled the all‐cause mortality.

show abstract

Section: Discussion/con Clus Ionsupporting

confidence: 87%

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In recent decades, several studies conducted in a wide range of different settings have focused on the association between transient ischaemic attack (TIA) and the risk of stroke [3][4][5][6][7][8][9][10][11][12][13][14]. Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged.…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, most of the recent studies followed participants for 5 years or less [7][8][9][10]13], so the long-term risk of stroke and associated predictors in patients with a history of TIA remains largely unknown. Thirdly, only one previous study was conducted in Germany [10] and, given that stroke incidence is particularly high in Germany [16], more research investigating risk factors for this neurological condition in this country is needed.…”

Section: Introductionmentioning

confidence: 99%

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Jacob

Tanislav

Kostev³

2019

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose Little is known about the long‐term association between transient ischaemic attack (TIA) and stroke. Therefore, the goal of this study was to analyze the long‐term risk of stroke and associated predictors in a large cohort of TIA patients followed in general practices in Germany. Methods This study included patients with an initial TIA diagnosis and subsequently followed up in one of 1262 general practices in Germany between January 2007 and December 2016 (N = 19 824 patients). The primary outcome of the study was the risk of ischaemic stroke within 10 years of the initial diagnosis of TIA. The secondary outcome was the identification of demographic, clinical and pharmaceutical variables significantly associated with stroke in TIA patients. Results Within 10 years of the initial TIA diagnosis, 18.3% of individuals were diagnosed with stroke. Age was positively associated with stroke, with hazard ratios ranging from 1.88 in patients aged 51–60 years to 4.00 in those aged >80 years (reference group: patients aged ≤50 years). Furthermore, male sex, hypertension, diabetes mellitus, atrial fibrillation and ischaemic heart diseases had an additional impact on the risk of stroke. Finally, new oral anticoagulants, heparins, diuretics, angiotensin II receptor blockers and platelet aggregation inhibitors were identified as protective factors. Conclusions In a cohort of almost 20 000 TIA patients, 18.3% were diagnosed with stroke within 10 years after the TIA index event. Several demographic, clinical and pharmaceutical variables significantly predicted the long‐term risk of stroke in TIA patients.

show abstract

“…mirabegron | atherosclerosis | plaque instability | lipolysis | adipose tissue A therosclerosis, the thickening, hardening, and loss of elasticity of the arterial vessel wall, is the major cause of morbidity and mortality worldwide (1)(2)(3)(4). Atherosclerotic lesions containing fatty plaques, cholesterol, and inflammatory cells are the primary causes of cardiovascular disease and stroke (5,6). Atherosclerosis as a chronic and progressive disease usually starts with damage of the endothelial layer of an artery.…”

mentioning

confidence: 99%

Bladder drug mirabegron exacerbates atherosclerosis through activation of brown fat-mediated lipolysis

Sui

Yang

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Mirabegron (Myrbetriq) is a β3-adrenoreceptor agonist approved for treating overactive bladder syndrome in human patients. This drug can activate brown adipose tissue (BAT) in adult humans and rodents through the β3-adrenoreceptor-mediated sympathetic activation. However, the effect of the mirabegron, approved by the US Food and Drug Administration, on atherosclerosis-related cardiovascular disease is unknown. Here, we show that the clinical dose of mirabegron-induced BAT activation and browning of white adipose tissue (WAT) exacerbate atherosclerotic plaque development. In apolipoprotein E −/− (ApoE −/− ) and low-density lipoprotein (LDL) receptor −/− (Ldlr −/− ) mice, oral administration of clinically relevant doses of mirabegron markedly accelerates atherosclerotic plaque growth and instability by a mechanism of increasing plasma levels of both LDL-cholesterol and very LDL-cholesterol remnants. Stimulation of atherosclerotic plaque development by mirabegron is dependent on thermogenesis-triggered lipolysis. Genetic deletion of the critical thermogenesis-dependent protein, uncoupling protein 1, completely abrogates the mirabegron-induced atherosclerosis. Together, our findings suggest that mirabegron may trigger cardiovascular and cerebrovascular diseases in patients who suffer from atherosclerosis. mirabegron | atherosclerosis | plaque instability | lipolysis | adipose tissue A therosclerosis, the thickening, hardening, and loss of elasticity of the arterial vessel wall, is the major cause of morbidity and mortality worldwide (1-4). Atherosclerotic lesions containing fatty plaques, cholesterol, and inflammatory cells are the primary causes of cardiovascular disease and stroke (5, 6). Atherosclerosis as a chronic and progressive disease usually starts with damage of the endothelial layer of an artery. Hypertension, hyperglycemia, hyperlipidemia especially hypercholesterolemia, smoking, obesity and diabetes, certain inflammatory disorders such as arthritis, infections, and drugs are the common risk factors of atherosclerotic plaque formation (7,8). Of interest, high incidences of myocardial infarction and stroke have been associated with colder ambient temperature and cold seasons (9, 10). Although the exact mechanism underlying low ambient temperature has not been elucidated, our recent findings show that cold-induced lipolysis in brown adipose tissue (BAT) and browning of white adipose tissue (WAT) may partly explain the high incidences of cardiovascular disease and stroke (11).The balance between energy deposition and dissipation is regulated by multiple factors, including the central nervous system, the endocrine system, food intake, physical exercise, pathological disease, and medications (12,13). Although WAT stores excessive energy in its lipid form, activated BAT specializes energy consumption by producing heat (14,15). Under certain conditions such as cold exposure, WAT, especially that located in the s.c. region, undergoes the brown-like transition, a process named browning WAT (16,17). Instead of stor...

show abstract

Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke

Abstract: In a follow-up to a 1-year study involving patients who had a TIA or minor stroke, the rate of cardiovascular events including stroke in a selected cohort was 6.4% in the first year and 6.4% in the second through fifth years. (Funded by AstraZeneca and others.).

Cited by 280 publications

References 16 publications

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Bladder drug mirabegron exacerbates atherosclerosis through activation of brown fat-mediated lipolysis

Contact Info

Product

Resources

About