Ischemic stroke is a strong independent risk factor for cardiovascular events

  • Sposato LA & al.
  • Neurology
  • 10 Mar 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 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.

Limitations

  • Possibly closer medical follow-up among patients with stroke.
  • Residual, unmeasured confounding.
  • Underdiagnosed cardiovascular disease in those lacking access to care.