Stroke: coexisting vascular disease tied to long-term risk for recurrent events

  • Boulanger M & al.
  • Neurology
  • 23 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients with transient ischaemic attack (TIA)/ischaemic stroke with coexisting cardiovascular disease (CVD) are at an increased risk for coronary events and recurrent ischaemic stroke compared with those without coexisting CVD.
  • The risk is higher particularly in those aged

Why this matters

  • Findings suggest that intensive lipid-lowering therapy may reduce the risk for recurrent events; however, the benefits from increased anti-thrombotic treatment might be offset by an increased risk for extracranial bleeding, particularly in older patients.

Study design

  • This population-based study included 2555 patients with TIA or ischaemic stroke who were treated according to the current secondary prevention guidelines.
  • Funding: National Institute for Health Research and others.

Key results

  • 640 (25.0%) patients had a history of coexisting CVD.
  • Patients with coexisting CVD vs those without had a higher 10-year risk of:
    • coronary events (22.8% vs 7.1%; P<.001 adjusted hr ci>
    • recurrent ischaemic stroke (31.5% vs 23.4%; P=.0049; aHR, 1.23; 95% CI, 0.99-1.53), particularly in patients aged
    • major ischaemic vascular events (45.1% vs 28.7%; P<.001 ahr ci>
  • Patients with non-cardioembolic TIA/stroke with coexisting CVD had a higher 10-year risk for major extracranial bleeds, particularly in patients aged
  • In contrast, the risk for intracerebral haemorrhage did not increase in patients with coexisting CVD (aHR, 0.17; 95% CI, 0.02-1.26).

Limitations

  • Results may not be generalisable as only white British population was included.