Risk and Cumulative Risk of Stroke Recurrence

Abstract

Background and Purpose-Estimates of risk of stroke recurrence are widely variable and focused on the shortterm. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence. Methods-Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI. Results-Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7-4.4) at 30 days, 11.1% (95% CI, 9.0 -13.3) at 1 year, 26.4% (95% CI, 20.1-32.8) at 5 years, and 39.2% (95% CI, 27.2-51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies. Conclusions-The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence. (Stroke. 2011;42:1489-1494.)Key Words: frequency Ⅲ predictors Ⅲ recurrence Ⅲ stroke P atients surviving an initial stroke are known to be at significantly increased risk for further strokes compared to the general population. 1 However, studies show considerable variation in the estimation of risk of stroke recurrence in both the early years and in the long-term after first stroke. 2 For example, the cumulative risk of stroke recurrence up to 5 years after initial stroke has been reported in population-based studies as 19% in Manhattan, 29% in Rochester, 30% in Oxfordshire, and 32% in Perth. [3][4][5][6] Accurate identification of the time at which stroke survivors are at increased risk for stroke recurrence is important for modifiable risk factors to target and to help reduce the risk of recurrence occurring. The aim of this systematic review and meta-analysis is to estimate the pooled cumulative risk of stroke recurrence at time points ranging from 30 days to 10 years after first-ever stroke. Materials and Methods Search Strategy and Selection CriteriaThis review included studies from hospital-based or communitybased stroke registers reporting the risk of stroke recurrence at any time point after first-ever stroke irrespective of study design and setting or language. Ovid Medline (1950 -November 2009), EMBASE (1950 -November 2009, and the Web of Science were searched using both medical subject heading terms ...

Thirty‐day recurrence after ischemic stroke or TIA

“…Studies on 30‐day recurrence are scarce and use varying definitions of recurring events. A meta‐analysis found a pooled cumulative risk of 3.1% for 30‐day recurrence, but risk estimates of 30‐day recurrence vary greatly (Mohan et al, 2011). Moreover, when classifying etiology by TOAST, around 40% of patients will end up with an undetermined or cryptogenic etiology when an apparent cause is lacking or identification of multiple competing etiologies (Hart et al, 2014).…”

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

“…Autonomic function is also altered post-stroke, where impairments in baroreflex function and BP control may result in inadequate cerebral perfusion (Sykora et al, 2009,Kong and Chuo, 2003. Given these issues, as well as the prevalence of cardiovascular co-morbidities among individuals with stroke (Kopunek et al, 2007,Roth, 1993 and elevated risk for recurrent events (Mohan et al, 2011), it is important to identify people with stroke who also present with OH.…”

Physical Activity Correlates with Arterial Stiffness in Community-dwelling Individuals with Stroke

“…Our participants represented individuals with relatively mild severity of stroke (all were capable of ambulation and living in the community), yet all subjects had compromised aerobic fitness levels and elevated arterial stiffness. Given the presence of cardiovascular comorbidities 17 and elevated risk for recurrent events in this population, 15 regular physical activity may attenuate the risk of adverse cardiovascular outcomes. Of note, a cross-sectional study of physically active individuals with spinal cord injury and age-matched recreationally active healthy controls found no differences in arterial stiffness between the 2 groups, 51 suggesting that physical activity may preserve arterial function, even among individuals with mobility limitations.…”

“…12 Whether arterial stiffness remains elevated in the later poststroke stages is also important, because the risk for recurrent events remains high; the 5-year rate for recurrent stroke is 26% and at 10 years is nearly 40%. 15 Cardiovascular risk factors are poorly managed in the later stages after stroke, 16 and comorbid cardiovascular conditions, such as hypertension and heart disease, are highly prevalent. 17 In addition, mobility limitations that persist after the initial neuromotor sequelae from stroke often lead to long-term inactivity and sedentary behaviors.…”