Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors: A Retrospective Population-Based Cohort Study

Abstract

Introduction: The impact of additional risk factors on major cardiovascular event (MACE) rates in patients with a history of myocardial infarction (MI) or ischaemic stroke (IS) treated with statins is not well defined. Methods: In this retrospective populationbased cohort study, patients with a history of MI or IS treated with moderate-or high-intensity statins were identified using Swedish national register data. Patients were incident (index event between July 2006 and December 2014 and followed from diagnosis) or prevalent (MI or IS before July 2006 and followed thereafter). Four subgroups were defined on the basis of additional risk factors associated with increased cardiovascular risk: diabetes mellitus with target organ damage; chronic kidney disease stages 3-4; index event within 2 years after prior MI or IS; and polyvascular disease. First and total MACE rates (i.e. MI, IS, or cardiovascular death) were calculated, and first MACE 10-year risks (prevalent cohort only) were predicted. Results: Numerically, MACE rates in subgroups were 1.5-3 times higher than in overall populations, and were highest in the 2 years after the index event. First MACE rates in the additional risk factor subgroups were 17.2-33.5 per 100 person-years for the incident cohorts and 9.9-13.2 per 100 person-years for the prevalent cohorts. Total MACE rates per 100 person-years were 20.1-39.8 per 100 person-years and 12.4-17.6 per 100 person-years, respectively. Conclusion: Despite previous use of moderateor high-intensity statins, patients with a history of MI or IS, and additional risk factors remain at very high cardiovascular risk.

Cardiovascular event rate and death in high‐risk secondary prevention patient cohort in Finland: A registry study

“…The event rate we estimated (14.3 events per 100 patient‐years) was similar in magnitude to a number of previous studies, 18 , 19 , 20 , 21 and lower than the event rate observed by Sciattella et al 22 (from 18.1 to 17.2 per 100 patient‐years) for patients with the acute coronary syndrome, IS, or PAD. However, in our study, we did not have data on the causes of deaths; thus, instead of CV death, all‐cause death was utilized as a composite in the CV events.…”

“…Diabetes and hypertension were the most important treatable predictors of recurrent events or death. Similarly, a previous registry study reported that additional CV risk factors elevated major CV event rates after MI or IS 1.5–3 times higher than in the overall MI and IS populations 18 . In a previous study, older age, prior stroke/TIA, prior atrial fibrillation, and elevated diastolic blood pressure at baseline were more likely associated with stroke than MI as the first event.…”

“…However, due to the constantly decreasing number of patients, the exact estimates should be interpreted with caution. Accelerated CV event recurrence was also observed after the first CV event in a recent acute coronary syndrome patient RCT 9 and in a Swedish registry study 18 …”

“…Similarly, a previous registry study reported that additional CV risk factors elevated major CV event rates after MI or IS 1.5–3 times higher than in the overall MI and IS populations. 18 In a previous study, older age, prior stroke/TIA, prior atrial fibrillation, and elevated diastolic blood pressure at baseline were more likely associated with stroke than MI as the first event. In the same study, a prior percutaneous coronary intervention was more likely to be associated with first MI than stroke.…”

“…Accelerated CV event recurrence was also observed after the first CV event in a recent acute coronary syndrome patient RCT 9 and in a Swedish registry study. 18 …”