NEW YORK (Reuters Health) – The absolute risk of MI or vascular death after a first ischemic stroke, even in patients without high-risk features, is comparable to levels used by national organizations to designate groups of patients at high risk of vascular events, according to researchers.
"In national guidelines, absolute long-term risk of MI or coronary death determines target low-density lipoprotein levels, but stroke patients are not explicitly addressed," Dr. Mitchell S. V. Elkind and colleagues from Columbia University, New York, write in the June issue of Stroke.
The researchers examined the absolute 5-year risk of cardiovascular outcomes and their predictors after a first ischemic stroke in 655 members of a population-based cohort. The primary outcome was first occurrence of MI or vascular death.
The mean subject age was 69.7 years and 44.6% were male. Overall, 18.9% of subjects were white, 27.6% were black, and 51.3% were Hispanic. A previous history of MI, coronary artery disease, congestive heart failure, atrial fibrillation, and peripheral artery disease was observed in 16.2%, 33.4%, 13.8%, 11.0%, and 21.6% of patients, respectively. The patients were followed-up for a median of 4.0 years.
"There were 86 vascular deaths, including MI (n = 17), congestive heart failure (n = 8), sudden cardiac death (n = 15), fatal stroke (n = 39), and other (n = 7)," Dr. Elkind’s team reports.
"The risk of MI or vascular death was relatively higher during the first year after stroke than for each of the subsequent 4 years."
Independent predictors of MI or vascular death included age greater than 70 years (hazard ratio [HR] 1.62), history of coronary artery disease (HR 1.76), and a history of atrial fibrillation (HR 1.76).
These data, along with more precise risk estimates, should help determine "the applicability of cardioprotective treatments to stroke patients," the researchers conclude.