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Community-based case-control study of childhood stroke risk associated with congenital heart disease

Christine K Fox1, Stephen Sidney2, Heather J Fullerton2

  • 1From the Departments of Neurology and Pediatrics, University of California, San Francisco (C.K.F., H.J.F.); and The Kaiser Permanente Northern California Division of Research, Oakland (S.S.). foxc@neuropeds.ucsf.edu.

Stroke
|December 18, 2014
PubMed

Insights

Congenital heart disease (CHD) significantly increases stroke risk in children. Even after surgery, children with CHD face a prolonged elevated risk, necessitating long-term stroke prevention strategies.

Area of Science:

  • Pediatric Neurology
  • Cardiology
  • Public Health

Background:

  • Understanding stroke risk factors in children with congenital heart disease (CHD) is crucial for developing effective prevention strategies.
  • A large community-based case-control study was conducted to analyze pediatric stroke associated with CHD.

Purpose of the Study:

  • To investigate the association between congenital heart disease (CHD) and the risk of stroke in children.
  • To identify specific risk factors for stroke in pediatric patients with CHD.

Main Methods:

  • A case-control study analyzed 2.5 million children (<20 years) from a Northern California healthcare plan.
  • Children with ischemic and hemorrhagic strokes were identified and matched with stroke-free controls.
  • Conditional logistic regression was used to determine stroke risk factors, including exposure to CHD diagnosed before stroke.

Main Results:

  • Congenital heart disease (CHD) was present in 4% of pediatric stroke cases versus 0.6% of controls, indicating a 19-fold increased stroke risk.
  • History of CHD surgery was associated with a >30-fold increased stroke risk, remaining significant even after excluding perioperative strokes.
  • CHD accounted for an estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population.

Conclusions:

  • Congenital heart disease (CHD) is a significant risk factor for stroke in children.
  • Children who undergo CHD surgery face an elevated stroke risk beyond the perioperative period.
  • Optimized long-term stroke prevention strategies are recommended for children with CHD, particularly those who have had surgery.
Abstract

Keywords:
epidemiology

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