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Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan Study

Mandip S Dhamoon1, Wanling Tai, Bernadette Boden-Albala

  • 1Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

Stroke
|April 14, 2007
PubMed

Insights

The 5-year risk of myocardial infarction (MI) or vascular death after ischemic stroke is substantial, even for lower-risk patients. These risks may inform treatment decisions for stroke survivors.

Area of Science:

  • Cardiovascular Epidemiology
  • Neurology
  • Public Health

Background:

  • Current national guidelines for managing cardiovascular risk factors like low-density lipoprotein levels primarily focus on absolute long-term risk of myocardial infarction (MI) or coronary death.
  • These guidelines do not explicitly address stroke patients, creating a potential gap in risk stratification and management strategies.
  • Understanding the specific cardiovascular risks following a first ischemic stroke is crucial for appropriate patient care.

Purpose of the Study:

  • To determine the absolute 5-year risk of major cardiovascular outcomes, specifically MI or vascular death, following a first ischemic stroke.
  • To identify independent predictors of these cardiovascular outcomes in a multiethnic cohort of stroke patients.
  • To compare the absolute risk levels in stroke patients with those used in national guidelines for cardiac patients.

Main Methods:

  • A prospective, population-based cohort study followed 655 patients aged 40 years or older who experienced a first ischemic stroke.
  • Annual follow-up assessed recurrent stroke, MI, and cause-specific mortality.
  • Kaplan-Meier methods calculated 5-year risks, while Cox proportional hazards models identified predictors of cardiovascular outcomes.

Main Results:

  • The overall 5-year risk of MI or vascular death was 17.4% in the cohort (mean age 69.7 years; 55.4% women; 51.3% Hispanic).
  • Independent predictors for MI or vascular death included age over 70 years, a history of coronary artery disease, and atrial fibrillation.
  • Even in the lowest-risk group (age ≤70 without coronary artery disease), the 5-year risk of MI or vascular death was 9.7%.

Conclusions:

  • The absolute risk of MI or vascular death after ischemic stroke is significant, even in patients without traditional high-risk features.
  • These risk levels are comparable to those used to define high-risk groups in national cardiovascular guidelines.
  • The findings suggest potential implications for treatment strategies, emphasizing the need to consider stroke patients alongside cardiac patients in risk management.
Abstract

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