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 <75 years.
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 [aHR], 3.07; 95% CI, 2.24-4.21);
- recurrent ischaemic stroke (31.5% vs 23.4%; P=.0049; aHR, 1.23; 95% CI, 0.99-1.53), particularly in patients aged <75 years (aHR, 1.74; 95% CI, 1.23-2.46); and
- major ischaemic vascular events (45.1% vs 28.7%; P<.001; aHR, 1.56; 95% CI, 1.30-1.88).
- Patients with non-cardioembolic TIA/stroke with coexisting CVD had a higher 10-year risk for major extracranial bleeds, particularly in patients aged <75 years (aHR, 2.71; 95% CI, 1.16-6.30).
- 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.
References
References
