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LONG TERM RISK OF STROKE VERSUS ACUTE CORONARY EVENTS AFTER TIA AND STROKE: A POPULATION–BASED STUDY
  1. Nicola LM Paul,
  2. Ziyah Mehta,
  3. Louise Silver,
  4. Olivia C Geraghty,
  5. Peter M Rothwell
  1. Stroke Prevention Research Unit, University of Oxford

    Abstract

    Background Some preventive treatments, such as statins and antihypertensive drug classes, differ in their relative effectiveness in preventing stroke versus coronary events. However, guidelines for secondary prevention of stroke are based partly on observations that fatal coronary events on long–term follow–up after TIA and stroke exceed fatal recurrent strokes. However, given the substantial fall in population incidence of coronary events in recent decades, it is uncertain whether this excess coronary risk remains.

    Method We prospectively ascertained all TIA, minor stroke (NIHSS≤5) and major stroke in a population based study (2002–2010). Patients received best secondary prevention according to current guidelines and were followed–up face–to–face for up to 8 years. Acute coronary events included fatal and non–fatal myocardial infarction and sudden cardiac death.

    Result Of 2035 consecutive patients with cerebrovascular events, 1928 were ischaemic (832 TIA; 778 minor stroke; 318 major stroke). Mean (SD) time to death or final follow–up was 3.1 (2.4) years, during which time there were 328 first recurrent strokes (8–year actuarial risk=24.6%, 95% CI 21.5–27.7) and 96 first acute coronary events (8–year actuarial risk=10.4%, 6.7–14.2; difference p<0.0001). The excess of recurrent stroke versus coronary events remained after exclusion of recurrences during the first 7–days: 214 vs 88 events. Death during follow–up was due to recurrent stroke in 88 patients and due to a coronary event in 42 (8–year risk: 5.4%, 12–15.2 vs 2.7%, 1.9–3.5; difference p<0.0001).

    Conclusion The long–term risk of major vascular events after TIA and stroke remains substantial, but about 70% of fatal and non–fatal events are now accounted for by recurrent stroke rather than acute coronary events.

    • PARKINSON'S DISEASE
    • STROKE
    • PARKINSON'S DISEASE
    • STROKE
    • PARKINSON'S DISEASE
    • STROKE
    • PARKINSON'S DISEASE
    • STROKE
    • PARKINSON'S DISEASE
    • STROKE
    • PARKINSON'S DISEASE
    • STROKE

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