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Severity of angina pectoris and risk of ischemic stroke
David Tanne1, Avraham Shotan, Uri Goldbourt
1Neufeld Cardiac Research Center, Chaim Sheba Medical Center, Tel Hashomer, Israel. tanne@post.tau.ac.il
Insights
The severity of angina pectoris in patients with coronary heart disease (CHD) independently predicts a higher risk of ischemic stroke. Higher angina classes correlate with increased ischemic stroke incidence, even after accounting for traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- Coronary heart disease (CHD) and ischemic stroke share common risk factors and pathological pathways, including atherosclerosis and thrombosis.
- Understanding the relationship between angina pectoris severity and stroke risk is crucial for secondary prevention strategies.
Purpose of the Study:
- To investigate the association between the severity of angina pectoris and the risk of developing incident ischemic stroke in patients with stable CHD.
- To determine if this association is independent of traditional vascular risk factors.
Main Methods:
- Analysis of 3122 patients with stable CHD from the Bezafibrate Infarction Prevention trial.
- Assessment of angina severity using the Canadian Cardiovascular Society (CCS) angina classification and heart failure using the New York Heart Association (NYHA) classification.
- Cox proportional-hazard modeling to adjust for conventional risk factors and confounders over a mean follow-up of 8.2 years.
Main Results:
- A dose-response relationship was observed between angina class severity and ischemic stroke risk (P<0.001).
- Patients with higher angina classes (1, 2, 3) had cumulative ischemic stroke rates of 5.7%, 8.4%, and 12.9%, respectively, compared to 4.7% in those with no angina.
- After adjusting for covariates, higher angina classes significantly increased the hazard ratio for ischemic stroke (Class 2: 1.66, Class 3: 2.35).
Conclusions:
- The severity of angina pectoris is a significant independent predictor of future ischemic stroke in patients with stable coronary heart disease.
- This finding highlights the importance of considering angina severity in stroke risk stratification beyond traditional risk factors.
Background And Purpose:
Ischemic stroke and coronary heart disease (CHD) share risk factors and pathogenic process, ie, atherosclerosis and thrombosis. We examined the relationship between severity of angina pectoris and its accompanying characteristics and the risk of incident ischemic stroke.
Methods:
We traced 3122 patients with stable CHD, included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. CHD was documented by a history of myocardial infarction > or =6 months and < 5 years before enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing. Severity of angina pectoris was assessed according to the Canadian Cardiovascular Society angina classification, and heart failure functional class according to the New York Heart Association (NYHA) classification. Patients with severe heart failure or unstable angina on enrollment were excluded.
Results:
During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The cumulative rate of ischemic stroke increased in a dose-response manner from 4.7% in patients with no angina to 5.7%, 8.4%, and 12.9% in patients with angina classes 1, 2, and 3, respectively (P<0.001). Patients with NYHA functional class 1 had a 5.5% rate of ischemic stroke versus 7.3% and 9.6% in patients with classes 2 and 3, respectively (P=0.05). In a Cox proportional-hazard model adjusting for conventional risk factors and potential confounders, the hazard ratio associated with angina class 1 was 1.20 (95% CI, 0.83 to 1.74); class 2, 1.66 (95% CI, 1.12 to 2.45); and class 3, 2.35 (95% CI, 1.08 to 5.13), as compared with patients with no angina. Hazard ratios of ischemic stroke associated with conventional risk factors were 1.55 for a 10-year age increment, 2.16 for diabetes mellitus, 1.81 for current smoking, and 1.29 for a 20 mm Hg increase in systolic blood pressure.
Conclusions:
Severity of angina pectoris in patients with stable CHD predicts an increased risk of subsequent ischemic stroke. The association between angina class and incident ischemic stroke is independent of traditional vascular risk factors.