Secondary prophylactic treatment and long‐term prognosis after <scp>TIA</scp> and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson, Sven-Erik

doi:10.1002/brb3.603

Cited by 9 publications

(6 citation statements)

References 76 publications

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“…In our analysis, a higher DBP at baseline and antiplatelet treatment were independent predictors for survival. This nding was coherent with the Sweden study that antiplatelet therapy in patients with ischemic stroke had a survival bene t [24]. Lowering BP after stroke is associated with a signi cant decrease in stroke recurrence, but the optimal target of BP for ischemic stroke patient is uncertain.…”

Section: Discussionsupporting

confidence: 66%

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Han

Choi

Leung³

et al. 2020

Preprint

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Background: We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.Methods: A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1-30/6/2010) were enrolled. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. Risks of recurrent cardiovascular events and death were estimated by Cox proportional hazards model. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary heart disease (CHD).Results: A total of 466 patients (mean age, 71.5 years) were enrolled. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CHD. Age was an independent risk factor for recurrent stroke, CHD and death. Statin therapy at baseline had a protective effect for recurrent stroke (hazard ratio [HR] =0.454, 95% confidence interval [CI] 0.269-0.766, P=0.003) and all-cause mortality (HR= 0.693, 95% CI 0.486-0.968, P=0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.Conclusions: Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.

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Section: Discussionsupporting

confidence: 66%

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Han

Choi

Leung³

et al. 2020

Preprint

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“…As in the previous study that did not include TC/TG levels in Cox regression analysis to assess predictors of death [24], this study also supports treatment of high systolic blood pressure, fasting blood glucose ≥6.1 mmol/L or history of diabetes, both in primary and secondary prevention, and administration of antithrombotic/antiplatelet therapy as secondary prophylaxis with no contraindications.…”

Section: Sex Men Womensupporting

confidence: 73%

“…This study included patients with TIA/stroke hospitalized in 1986 at the Stroke unit or Department of Neurology and who had a fasting lipid analysis performed at admission. All patients were followed up until February 2011 [24]. TIA was defined as an acute onset of focal neurological symptom(s) and sign(s) or retinal that had been transient within 24 hours.…”

Section: Methodsmentioning

confidence: 99%

Long-term prognosis related to fasting total-cholesterol and triglyceride levels after TIA/stroke

Eriksson¹

2019

Mathews Journal of Neurology

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Background and Aim: To identify statistically significant differences in the risk of (recurrent) stroke, myocardial infarction (MI), or mortality between groups with different levels of fasting total-cholesterol (TC) and triglyceride (TG). Material and Methods: A total of 124 men and 96 women who were hospitalized in 1986 either at the Stroke Unit or Department of Neurology, Linköping, had their lipid levels assessed at admission and received follow up retro-/prospectively until February 2011. Results: Men had an almost linear correlation between increasing TC levels (< 5 mmol/L; 5-6.4 mmol/L; and ≥ 6.5 mmol/L), and increasing risk of MI during life, P = 0.016, and cardiovascular death (CVD) (not index stroke), P = 0.002; women had a U-shaped correlation. Men had an inverse correlation between TC levels and death due to cancer, P=0.008. Comparisons pairwise between sexes: TC 5-6.4 mmol/L, increased survival in women, P=0.038. According to Cox regression analyses, TC ≥ 6.5 mmol/L was a predictor of MI, and TG > 2.2 mmol/L had an unfavourable effect on survival. Conclusions: TC and TG levels measured after admission effect men and women differently regarding the risk for MI and CVD. These differences of outcomes between sexes may support the fact that the indication for lipid-lowering treatment is partly dependent on sex.

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“…Of 577 potentially eligible records identified for the systematic review, we identified 28 eligible articles reporting on 23 studies 2 , 3 , 4 , 5 , 9 , 17 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 (9 trials and 14 observational studies) including 4889 patients with cryptogenic TIA/stroke and PFO who were receiving medical treatment alone (eFigure 1 in the Supplement ). Noneligible studies included observational studies 39 , 40 , 41 , 42 , 43 , 44 and 1 randomized clinical trial (47 patients with cryptogenic stroke/TIA randomized to either warfarin or aspirin) 45 with a population below the threshold for inclusion (<100 patients with cryptogenic TIA/stroke enrolled); observational studies on an unsuitable population (mostly retrospective studies selecting patients on the basis of echocardiographic finding of a PFO, where the analysis included patients without stroke, or patients with both cryptogenic and noncryptogenic TIA/stroke) 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ; secondary publications of an included study 55 , 56 ; and a study that reported only composite outcomes of TIA/stroke and peripheral embolism. 57 We contacted 8 authors and obtained unpublished data from 4 individuals.…”

Section: Resultsmentioning

confidence: 99%

Prognosis of Cryptogenic Stroke With Patent Foramen Ovale at Older Ages and Implications for Trials

Mazzucco

Rothwell

2020

JAMA Neurol

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IMPORTANCE Patent foramen ovale (PFO) closure may prevent recurrent stroke after cryptogenic transient ischemic attack (TIA) or stroke (TIA/stroke) in patients aged 60 years or younger. Patent foramen ovale is associated with cryptogenic stroke in the older population, but risk of recurrence is unknown. Data on prognosis of patients receiving medical treatment at older ages (Ն60 years) are essential to justify trials of PFO closure. OBJECTIVE To examine the age-specific risk of recurrence in patients with cryptogenic TIA/stroke with PFO. DESIGN, SETTING, AND PARTICIPANTS A prospective study was nested in the population-based Oxford Vascular Study between September 1, 2014, and March 31, 2019, with face-to-face follow-up for 5 years. A total of 416 consecutive patients with a diagnosis of cryptogenic TIA or nondisabling stroke, screened for PFO at a rapid-access TIA/stroke clinic, were included. A systematic review and meta-analysis of cohort studies reporting on ischemic stroke recurrence after cryptogenic TIA/stroke in patients with PFO who were receiving medical therapy alone, or with PFO vs no-PFO was conducted. Sample size calculation for future trials on PFO closure was performed for patients aged 60 years or older. EXPOSURES Patent foramen ovale and age as modifiers of risk of recurrent stroke after cryptogenic TIA/stroke in patients receiving only medical therapy. MAIN OUTCOMES AND MEASURES Risk of ischemic stroke recurrence in patients with cryptogenic TIA/stroke and PFO receiving medical therapy only, and in patients with vs without PFO, stratified by age (<65 vs Ն65 years), as well as sample-size calculation for future trials of PFO closure in patients aged 60 years or older. RESULTS Among the 153 Oxford Vascular Study patients with PFO (mean [SD] age, 66.7 [13.7] years; 80 [52.3%] men), recurrent ischemic stroke risk (2.05 per 100 patient-years) was similar to the pooled estimate from a systematic review of 23 other studies (9 trials and 14 observational studies) (2.00 per 100 patient-years; 95% CI, 1.55-2.58). However, there was heterogeneity between studies (P < .001 for heterogeneity), owing mainly to risk increasing with mean cohort age (meta-regression: R 2 = 0.31; P = .003). In the pooled analysis of 4 studies including patients with or without PFO, increased risk of stroke recurrence with PFO was seen only at age 65 years or older (odds ratio, 2.5; 95% CI, 1.4-4.2; P = .001 for difference; P = .39 for heterogeneity). The pooled ischemic stroke risk was 3.27 per 100 patient-years (95% CI, 2.59-4.13) in 4 cohorts with mean age 60 years or older. Assuming the more conservative 2.0 per 100 patient-years ischemic stroke risk in the PFO nonclosure arms of future trials in patients aged 60 years or older, projected sample sizes were 1080 per arm for 80% power to detect a 33% relative risk reduction. CONCLUSIONS AND RELEVANCE The findings of this study suggest that age is a determinant of risk of ischemic stroke after cryptogenic TIA/stroke in patients with PFO, such that trials of PFO closure at older ...

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Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Cited by 9 publications

References 76 publications

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Long-term prognosis related to fasting total-cholesterol and triglyceride levels after TIA/stroke

Prognosis of Cryptogenic Stroke With Patent Foramen Ovale at Older Ages and Implications for Trials

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