Increased Risk for Major Cardiovascular Events Following Ischemic Stroke

First-ever ischemic stroke is associated with increased risk for major cardiovascular events (MACE) among older adults without pre-existing cardiovascular disease, according to study results published in Neurology.

Although previous studies have suggested that cardiovascular risk is increased in patients with acute stroke due to a greater susceptibility to shared vascular risk factors, no study assessed the cardiovascular risk among patients with ischemic stroke, compared with adults without stroke.

The goal of the current population-based cohort study of elderly patients without known preexisting cardiovascular disease was to explore the association between first-ever acute ischemic stroke and the risk for MACE, including acute myocardial infarction, acute coronary syndrome, percutaneous coronary intervention or coronary artery bypass graft surgery, incident coronary artery disease or congestive heart failure, or cardiovascular death.  

The study cohort included adults ≥66 years of age without known cardiovascular disease, residing in Ontario between April 1, 2002, and March 31, 2012. A total of 21,931 adults with first-ever ischemic stroke and 71,696 individuals with no history of stroke were included.

At 1 year, 1996 patients (9.1%) with stroke had a MACE, compared with 1654 patients (2.3%) without stroke (unadjusted event rate of 10.9 per 100 person-years vs 2.4 per 100 person-years, respectively). The risk for MACE was greater among patients with first-ever ischemic stroke, compared with controls without stroke at 1 year (hazard ratio [HR] 4.5, 95% CI, 4.3 to 4.8; P <.0001) and 3 years (HR 2.7, 95% CI, 2.6 to 2.9; P <.0001).

After accounting for the time-varying association between stroke and cardiovascular events, incident MACE risk was 25-fold higher within 30 days after the index date (HR 25.0, 95% CI, 20.5–30.5; P <.0001) and decreased to 5-fold between days 31 and 90 (HR 4.8, 95% CI, 4.1 to 5.7; P <.0001) and 2-fold from day 90 onward (HR 2.2, 95% CI, 2.0 to 2.4; P <.0001).

First-ever ischemic stroke was also associated with all prespecified secondary outcomes, except for percutaneous coronary intervention or coronary artery bypass graft surgery and incident atrial fibrillation at 1 and 3 years.

The study had several limitations, according to the researchers, including possible bias as patients who had a stroke had more extensive investigation following the acute event, leading to increased diagnoses of cardiovascular disease; residual unmeasured confounders; and no adjustment for medications used during follow-up as time-varying covariate.

“Understanding the potential mechanisms of stroke-associated MACE will aid in the development of novel therapies for preventing heart disease after stroke,” concluded the researchers.

Reference

Sposato LA, Lam M, Allen B, Richard L, Shariff SZ, Saposnik G. First-ever ischemic stroke and increased risk of incident heart disease in older adults [published online ahead of print, March 10, 2020]. Neurology. doi: 10.1212/WNL.0000000000009234