Risk of recurrent stroke in Rotterdam between 1990 and 2020: a population-based cohort study

Berghout, Brendan; Bos, Daniël; Koudstaal, Peter J.; Ikram, M. Arfan; Ikram, M. Arfan

doi:10.1016/j.lanepe.2023.100651

Cited by 12 publications

(3 citation statements)

References 29 publications

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“…The main outcome was incident ASCVD, composed of myocardial infarction, coronary revascularization, non-hemorrhagic stroke, and ASCVD mortality. 19,20 Events were adjudicated until January 1 st , 2015. Follow-up and adjudication of outcome events was based on the general practitioners' and medical specialists' reports and verified by the study physicians, in detail described previously.…”

Section: Assessment Of Ascvdmentioning

confidence: 99%

“…Follow-up and adjudication of outcome events was based on the general practitioners' and medical specialists' reports and verified by the study physicians, in detail described previously. 19,20…”

Section: Assessment Of Ascvdmentioning

confidence: 99%

“…History of ASCVD was defined as any of the following: myocardial infarction, coronary or other arterial revascularization procedure, stroke, transient ischemic attack, or repeated prescription of nitrates (as a proxy for angina pectoris). 19,20,22,23 We excluded individuals with age-specific levels of NT-proBNP indicative of underlying heart failure (if age <50 years and NT-proBNP >450 pg/mL, or age 50-75 years and NT-proBNP >900 pg/mL, or age >75y and NT-proBNP >1800 pg/mL). 24…”

Section: Statin Trial Eligibilitymentioning

confidence: 99%

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ASCVD risk refinement with NT-proBNP for statin allocation among low- and intermediate risk individuals

Pavlović,

Kavousi,

Ikram

et al. 2024

Preprint

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Background: Statin trials targeting low- to intermediate risk individuals, namely MEGA, JUPITER, and HOPE-3, have demonstrated benefit of statin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD), but are poorly reflected in guideline recommendations for primary prevention of ASCVD. N-terminal pro-B-type natriuretic peptide (NT-proBNP) may refine ASCVD risk in low-to intermediate risk individuals eligible for HOPE-3, JUPITER and MEGA, and aid statin initiation in low- to intermediate risk populations. Methods: 5434 participants, aged 45 years and above from the prospective population-based Rotterdam Study, free of ASCVD, heart failure, and diabetes, were included between 1997 and 2008. Eligibility criteria for MEGA, JUPITER, and HOPE-3 trials were checked for each participant. ASCVD event rates, hazard ratios (HR), 5-year numbers needed to treat (NNT5y), and screen (NNS5y) per trial eligible population and NT-proBNP category (?50, 50-100, and >100 pg/mL) were calculated. Results: Median age was 61.6 years, 58.9% were women, median NT-proBNP was 60 pg/mL. The proportions of participants eligible for MEGA, JUPITER and HOPE-3 were 34.9%, 10.4% and 23.7%. Incidence rates per 1000 person-years for ASCVD were 10.4 (95%CI: 60.1-67.9) for MEGA, 16.8 (95%CI: 13.6-20.6) for JUPITER, and 12.1 (95%CI: 10.3-14) for HOPE-3. Adjusted HR in trial eligible individuals for NT-proBNP >100 pg/mL compared to ?50 pg/mL level were 1.73 (95%CI: 1.21-2.47), 1.46 (95%CI: 0.80-2.66) and 1.50 (95%CI: 0.99-2.26), respectively. Estimated NNT5y among trial eligible individuals with NT-proBNP levels >100 pg/mL based on high-intensity statin treatment, varied from 23 to 34 to prevent one ASCVD event, while NNS5y ranged between 56 and 134. Conclusions: NT-proBNP level >100 pg/mL identifies individuals at the highest ASCVD risk among low- to intermediate risk populations who are likely to benefit from statin treatment at acceptable NNT5y and NNS5y.

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Section: Assessment Of Ascvdmentioning

confidence: 99%

Section: Assessment Of Ascvdmentioning

confidence: 99%

Section: Statin Trial Eligibilitymentioning

confidence: 99%

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ASCVD risk refinement with NT-proBNP for statin allocation among low- and intermediate risk individuals

Pavlović,

Kavousi,

Ikram

et al. 2024

Preprint

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Sekundärprophylaxe des ischämischen Schlaganfalls

Schmidbauer,

Wischmann,

Dimitriadis

et al. 2023

Innere Medizin

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Case management-based post-stroke care for patients with acute stroke and TIA (SOS-Care): a prospective cohort study

Barlinn,

Winzer,

Helbig

et al. 2024

J Neurol

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Background The high incidence of stroke recurrence necessitates effective post-stroke care. This study investigates the effectiveness of a case management-based post-stroke care program in patients with acute stroke and TIA. Methods In this prospective cohort study, patients with TIA, ischemic stroke or intracerebral hemorrhage were enrolled into a 12-month case management-based program (SOS-Care) along with conventional care. Control patients received only conventional care. The program included home and phone consultations by case managers, focusing on education, medical and social needs and guideline-based secondary prevention. The primary outcome was the composite of stroke recurrence and vascular death after 12 months. Secondary outcomes included vascular risk factor control at 12 months. Results From 11/2011 to 12/2020, 1109 patients (17.9% TIA, 77.5% ischemic stroke, 4.6% intracerebral hemorrhage) were enrolled. After 85 (7.7%) dropouts, 925 SOS-Care patients remained for comparative analysis with 99 controls. Baseline characteristics were similar, except for fewer males and less frequent history of dyslipidemia in post-stroke care. At 12 months, post-stroke care was associated with a reduction in the composite endpoint compared to controls (4.9 vs. 14.1%; HR 0.30, 95% CI 0.16–0.56, p < 0.001), with consistent results in ischemic stroke patients alone (HR 0.32, 95% CI 0.17–0.61, p < 0.001). Post-stroke care more frequently achieved treatment goals for hypertension, dyslipidemia, diabetes, BMI and adherence to secondary prevention medication (p < 0.05). Conclusions Case management-based post-stroke care may effectively mitigate the risk of vascular events in unselected stroke patients. These findings could guide future randomized trials investigating the efficacy of case management-based models in post-stroke care.

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Risk of recurrent stroke in Rotterdam between 1990 and 2020: a population-based cohort study

Cited by 12 publications

References 29 publications

ASCVD risk refinement with NT-proBNP for statin allocation among low- and intermediate risk individuals

ASCVD risk refinement with NT-proBNP for statin allocation among low- and intermediate risk individuals

Sekundärprophylaxe des ischämischen Schlaganfalls

Case management-based post-stroke care for patients with acute stroke and TIA (SOS-Care): a prospective cohort study

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