Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Abstract

Background Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events. Hypothesis Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk. Methods Two cohorts were studied in a retrospective Medicare 20% random sample—a 2008 cohort with up to 6 years of follow‐up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of follow‐up (MI, N = 26 548; IS, N = 17 728). Results In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient‐years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort. Conclusion In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high‐risk patients, particularly those with diabetes.

<p>Demographic And Clinical Characteristics Of Patients Prescribed Proprotein Convertase Subtilisin/kexin Type 9 Inhibitor Therapy And Patients Whose Current Lipid-Lowering Therapy Was Modified</p>

“…In a recently published study of recurrent MI and IS in Medicare beneficiaries, the rate of recurrent IS during the patients' first year of survival after an event of IS (6.7%) was similar to that of patients with recurrent MI (7.2%), which further supports the need for aggressive intervention for secondary prevention in patients with MI or IS. 27 Other important areas for future research will include investigating how the CV risk profile of patients in our cohort compares with the risk profiles defined in the 2018 ACC/AHA guideline, as well as assessing the impact of new guideline and the potential influence on physician prescribing practices for PCSK9 inhibitor therapy in future cohort analyses. Studies that assess the characteristics of filled vs abandoned prescriptions and impact on CV outcomes would also be of interest in the context of the changing value and access landscape for PCSK9 inhibitors.…”

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

“…Along these lines, Han Jing et al analyzed stroke recurrence in a rural population and found rates similar to those of the ARTPER study: the recurrent stroke rate was 22.5% at five years [ 11 ]. As in other studies, diabetes was an independent risk factor [ 11 , 24 ]. The ARTPER study looked at urban patients who had easy access to the hospital and primary health center.…”

“…In our study, the risk of cardiac recurrence (33%) was greater than stroke recurrence (17%). In contrast, the Suying Li et al study [ 11 ] with older patients with a prior MI or stroke, found a smaller difference between recurrence types: the cumulative incidence of recurrence at six years was 14.3% for recurrent MI and 13.4% for recurrent stroke. This difference may be due to the fact that the population in this study was older, was more predominantly female, that follow-up was at six years, or that there was some comorbidity, such as carotid stenosis and endarterectomy.…”

“…There is also mixed research on the recurrence of stroke and MI after a first event [ 10 , 11 , 12 ] and the factors associated with such recurrence, including the role of pathological ABI, albeit with contradictory results [ 13 , 14 , 15 , 16 , 17 ].…”

Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention

“…При этом по сравнению с первым месяцем с 31-го дня до 1 года происходил резкий спад заболеваемости инсультом (в 3,1 раза) [6]. Частота развития инсульта через 1 мес после развития ИМ составляет 1,2% [20], в течение года после ИМ инсульт развивается у 1,7-2,1% больных [21,25]. Согласно анализу крупных исследований в течение первого года после ИМ частота развития ишемического инсульта составляет 4,1% [11,23].…”