Prevalence of subclinical coronary artery disease in ischemic stroke patients
Kohichiro Iwasaki1, Kayo Haraoka1, Toshikazu Hamaguchi2
1Department of Cardiology, Okayama Kyokuto Hospital, Okayama, Japan.
Insights
Ischemic stroke patients have a high prevalence of subclinical coronary artery disease (CAD). A quarter of these patients exhibit high-risk CAD, underscoring the link between stroke and cardiovascular disease.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Ischemic stroke is increasingly recognized as a significant risk factor for coronary artery disease (CAD).
- Understanding the prevalence of subclinical CAD in stroke patients is crucial for risk stratification and management.
Purpose of the Study:
- To determine the prevalence of subclinical CAD in patients with ischemic stroke.
- To compare CAD prevalence in ischemic stroke patients versus non-stroke individuals.
Main Methods:
- Coronary calcium score (CCS) was measured in 151 ischemic stroke patients and 151 matched controls.
- High-risk CAD was defined as CCS ≥ 400.
- Logistic regression analysis identified predictors of high-risk CAD.
Main Results:
- Ischemic stroke patients had significantly higher CCS than controls (median 64 vs. 3, p<0.0001).
- High-risk CAD (CCS≥400) was found in 24.5% of stroke patients versus 9.3% of controls (p<0.0001).
- Age, diabetes, stroke, and male sex were independent predictors of high-risk CAD.
Conclusions:
- Subclinical CAD is highly prevalent in ischemic stroke patients.
- Approximately 25% of ischemic stroke patients have high-risk CAD.
- Stroke itself is an independent predictor of high-risk CAD.
Background:
Recently, ischemic stroke has emerged as a new coronary artery disease (CAD) risk equivalent. Our purpose is to study the prevalence of CAD in ischemic stroke patients compared with that in non-stroke patients.
Methods And Results:
We measured coronary calcium score (CCS) in 151 ischemic stroke patients without known CAD (stroke group) and compared it with 151 age- and sex-matched non-stroke patients (control group). CCS was significantly higher in the stroke group than in the control group (stroke group, median: 64, interquartile range: 3-382 vs. control group, median: 3, interquartile range: 0-65, p<0.0001). High-risk CAD, defined as a CCS≥400, was detected in 24.5% of the stroke group compared with 9.3% of the control group (p<0.0001). Agreement between the Framingham risk score and CCS was found in only 62 patients (41.1%). In a multiple logistic regression analysis, age [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.03-1.14], diabetes (HR 2.97, 95%CI 1.52-5.78), stroke (HR 3.85, 95%CI 1.89-7.81), and male sex (HR 4.41, 95%CI 1.82-0.75) were significantly associated with high-risk CAD (p<0.001).
Conclusions:
Our results show that the prevalence of subclinical CAD in ischemic stroke patients was high, and that a quarter of them had high-risk CAD. Age, diabetes, stroke, and male sex were independent predictors of high-risk CAD.
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