- Older adults experiencing a first ischemic stroke have a dramatically increased risk for major adverse cardiovascular events (MACE) in the subsequent year, especially in the first month.
Why this matters
- This population may benefit from intensified intervention.
- Editorial: the findings support a link between ischemic stroke and MACE.
- Compared with unaffected peers, older adults with a first ischemic stroke had an increased unadjusted risk for MACE at 1 year:
- HR, 4.54 (95% CI, 4.26-4.84).
- Adjusted risk (HRs; 95% CIs) varied by time since stroke:
- 0-30 days: 25.00 (20.49-30.51);
- 31-90 days: 4.85 (4.11-5.72); and
- 91-365 days: 2.17 (1.98-2.37).
- Greatest increase seen for component of cardiovascular death:
- HR, 5.89 (95% CI, 5.31-6.52).
- Similar findings for risk at 3 years (HR, 2.74; 95% CI, 2.63-2.86), with 80% elevation during 91-1095 days (HR, 1.80; 95% CI, 1.71-1.90).
- Ontario, Canada, population-based cohort study 2002-2012 of residents ages ≥66 years without known cardiovascular disease:
- 21,931 individuals with first ischemic stroke and
- 71,696 propensity-matched unaffected individuals.
- Main outcome: 1-year MACE (myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, cardiovascular death).
- Funding: ICES Western.
- Possibly closer medical follow-up among patients with stroke.
- Residual, unmeasured confounding.
- Underdiagnosed cardiovascular disease in those lacking access to care.