Recurrent stroke and cardiac risks after first ischemic stroke

Dhamoon, Mandip S.; Sciacca, Robert R.; Rundek, Tatjana; Sacco, Ralph L.; Elkind, M. S. V.

doi:10.1212/01.wnl.0000201253.93811.f6

Cited by 285 publications

(221 citation statements)

References 46 publications

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“…This article updates the general assumption that cardiac events remained the main cause of death after stroke 1, 2, 3, 23. The significant decrease observed over time in the risks of fatal MI and cardiac death but the relative stability of the risk of fatal recurrent strokes over time are likely to explain previous findings.…”

Section: Discussionsupporting

confidence: 68%

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger

Béjot

Rothwell

et al. 2018

JAHA

123

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BackgroundUncertainties remain about the current risk of myocardial infarction (MI) after ischemic stroke or transient ischemic attack.Methods and ResultsWe undertook a systematic review to estimate the long‐term risk of MI, compared to recurrent stroke, with temporal trends in ischemic stroke/transient ischemic attack patients. Annual risks and 95% confidence intervals (95% CI) of MI and recurrent stroke were estimated using random‐effect meta‐analyses. We calculated incidence ratios of MI/recurrent stroke, for fatal and nonfatal events, using similar analyses. Rate ratios for MI in patients with potential risk factors compared to those without were calculated using Poisson regression.A total of 58 studies (131 299 patients) with a mean (range) follow‐up of 3.5 (1.0‐10.0) years were included. The risk of MI was 1.67%/y (95% CI 1.36‐1.98, P het<0.001 for heterogeneity) and decreased over time (P int=0.021); 96% of the heterogeneity between studies was explained by study design, study period, follow‐up duration, mean age, proportion of patients on antithrombotic therapy, and incident versus combined ischemic stroke/transient ischemic attack. The risk of recurrent stroke was 4.26%/y (95% CI 3.43‐5.09, P het<0.001), with no change over time (P int=0.63). The risk of fatal MI was half the risk of recurrent strokes ending in fatality (incidence ratio=0.51, 95% CI 0.14‐0.89, P het=0.58). The risk of nonfatal MI was 75% smaller than the risk of recurrent nonfatal stroke (incidence ratio=0.25, 95%CI 0.02‐0.50, P het=0.68). Male sex, hypertension, coronary and peripheral artery diseases were associated with a doubled risk of MI.ConclusionsAfter ischemic stroke/transient ischemic attack, the risk of MI is currently <2%/y, and recurrent stroke is a more common cause of death than MI.

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Section: Discussionsupporting

confidence: 68%

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger

Béjot

Rothwell

et al. 2018

JAHA

123

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“…19 In the REACH subset of participants with cardiovascular disease, 83% had hypertension, 58% had hypercholesteremia, 39% were overweight, and 16.5% were obese. 18 In NOMAS, 78.2% had hypertension, 36% had LDL >130mg/dL, 43.4% had diabetes, and 21.3% currently smoked.…”

Section: Discussionmentioning

confidence: 98%

“…18 In NOMAS, 78.2% had hypertension, 36% had LDL >130mg/dL, 43.4% had diabetes, and 21.3% currently smoked. 19 Reasons for high rates of sub-optimal risk factor management are complex; multidisciplinary studies are needed to develop new strategies to bridge the evidence-practice gap. Mass media, especially television, is cited more often (32%) than primary physicians (20%) as a prime source of stroke information.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Survivors of Stroke

Kopunek

Michael

Shaughnessy

et al. 2007

American Journal of Preventive Medicine

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Background-Stroke survivors are at significant risk for recurrent stroke and cardiovascular disease. Inadequately managed modifiable risk factors increase the threat of recurrent stroke, development of new co-morbidities, and double the risk of premature mortality. The purpose of this study was to determine the prevalence of modifiable cardiovascular risk factors in stroke survivors who completed a research screening evaluation for entry into exercise rehabilitation studies. The sample collected between January 2001 and June 2005 evaluated 364 community-dwelling men and women aged 34 to 88 years living in Baltimore, Maryland.

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“…Patients with either TIA and/or an ischemic or hemorrhagic stroke have besides an increased risk of suffering (recurrent) stroke, increased risks of experiencing myocardial infarction (MI) or a vascular cause of death over long‐term observation (Appelros, Gunnarsson, & Terent, 2011; Brønnum‐Hansen, Davidsen, & Thorvaldsen, 2001; Burns et al., 2011; Dhamoon, Sciacca, Rundek, Sacco, & Elkind, 2006; Eriksson & Olsson, 2001; Hardie, Hankey, Jamrozik, Broadhurst, & Anderson, 2004; Touze et al., 2005). Warfarin alone or in combination with aspirin was superior to aspirin alone regarding endpoints, but it increased the risk of major, nonfatal bleeding after MI (Hurlen, Abdelnoor, Smith, Erikssen, & Arnesen, 2002).…”

Section: Introductionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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ObjectivesTo assess long‐term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given.Materials and MethodsRetro/prospective follow‐up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011.ResultsA total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first‐line treatment had beneficial effects on survival: AC OR 0.67 (0.5–0.9), APT 0.67 (0.52–0.88) versus untreated.ConclusionsPatients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.

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Recurrent stroke and cardiac risks after first ischemic stroke

Cited by 285 publications

References 46 publications

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Cardiovascular Risk in Survivors of Stroke

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

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