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Effect of coexisting vascular disease on long-term risk of recurrent events after TIA or stroke

Marion Boulanger1, Linxin Li1, Shane Lyons1

  • 1From the Centre for Prevention of Stroke and Dementia (M.B., L.L., S.L., N.G.L., M.M.K., L.S., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK; and Service de Neurologie (M.B., E.T.), CHU Caen Normandie, UNICAEN, Normandie Université, INSERM U1237, Caen, France.

Neurology
|July 25, 2019
PubMed

Insights

Patients with transient ischemic attack (TIA) or ischemic stroke and existing cardiovascular disease face a high risk of recurrent events. Current guidelines may not be sufficient, suggesting a need for more intensive lipid-lowering strategies.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Secondary prevention guidelines aim to reduce recurrent ischemic events after TIA or stroke.
  • Coexisting cardiovascular disease (CVD) may impact the effectiveness of current secondary prevention strategies.

Purpose of the Study:

  • To assess the risk of recurrent ischemic events in patients with TIA or ischemic stroke who also have existing cardiovascular disease.
  • To evaluate if current secondary prevention guidelines adequately manage these high-risk patients.

Main Methods:

  • A population-based study (Oxford Vascular Study) in the UK from 2002-2014.
  • Consecutive patients with TIA or ischemic stroke were followed, with treatment adhering to current guidelines.
  • Risk stratification was performed based on the presence of coexisting cardiovascular disease (coronary or peripheral artery disease).

Main Results:

  • Patients with TIA/stroke and coexisting CVD had a significantly higher 10-year risk of coronary events (22.8% vs. 7.1%) and recurrent ischemic stroke (31.5% vs. 23.4%).
  • These increased risks persisted despite similar medication use (antithrombotics, lipid-lowering) compared to patients without CVD.
  • A higher risk of extracranial bleeds was observed in patients with noncardioembolic TIA/stroke and coexisting CVD, particularly those under 75 years.

Conclusions:

  • Patients with TIA/stroke and coexisting cardiovascular disease remain at high risk for recurrent ischemic events, even with current management protocols.
  • More aggressive lipid-lowering therapy may be warranted.
  • Increased antithrombotic treatment benefits could be negated by a higher risk of extracranial bleeding.
Abstract

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