First-ever ischemic stroke and increased risk of incident heart disease in older adults
Luciano A Sposato1, Melody Lam2, Britney Allen2
1From ICES Western (L.A.S., M.L., B.A., L.R., S.Z.S.); Heart & Brain Lab (L.A.S.), Department of Clinical Neurological Sciences (L.A.S.), Schulich School of Medicine and Dentistry, Department of Epidemiology & Biostatistics (L.A.S.), Department of Anatomy & Cell Biology (L.A.S.), Robarts Research Institute (L.A.S.), and Arthur Labatt Family School of Nursing (S.Z.S.), Western University; Lawson Health Research Institute (L.A.S., S.Z.S.), London, Ontario, Canada; ICES Central (G.S.); Department of Medicine (G.S.), Division of Neurology, and Li Ka Shing Knowledge Institute (G.S.), St. Michael's Hospital, University of Toronto, Ontario, Canada; and Laboratory for Social and Neural Systems Research (G.S.), Department of Economics, University of Zurich, Switzerland. Luciano.Sposato@LHSC.on.ca.
Insights
First-ever ischemic stroke significantly increases the risk of major adverse cardiovascular events (MACE) in older adults without prior heart disease. This elevated risk is highest in the first month post-stroke.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Post-stroke cardiac complications are frequent but their cause is unclear.
- Potential causes include shared risk factors, pre-existing heart disease, or stroke-induced cardiac injury.
Purpose of the Study:
- To investigate the association between first-ever ischemic stroke and incident cardiovascular complications in patients without known heart disease.
- To test the hypothesis that stroke independently increases cardiovascular risk.
Main Methods:
- Population-based cohort study of Ontario residents aged ≥66 years (2002-2012) without prior cardiovascular disease.
- Compared incident risk of major adverse cardiovascular events (MACE) within 1 year for first-ever ischemic stroke patients versus propensity-matched controls (4:1 ratio).
- Used Cox regression to estimate cause-specific hazard ratios, adjusting for confounding variables.
Main Results:
- Included 21,931 ischemic stroke patients and 71,696 controls.
- First-ever ischemic stroke was linked to a 4.5-fold increased risk of MACE.
- Adjusted MACE risk was highest within 30 days (HR 25.0), decreasing over the subsequent 11 months.
Conclusions:
- Ischemic stroke is independently associated with a higher risk of incident MACE in older adults.
- The underlying mechanisms—stroke-associated cardiac injury, subclinical cardiovascular disease, or both—require further investigation.
Objective:
Poststroke cardiac complications are common. It is unknown whether the reason is shared risk factors and preexisting heart disease or stroke-associated myocardial and coronary injury. We tested the hypothesis that first-ever ischemic stroke is associated with increased risk of incident cardiovascular complications in patients without known preexisting cardiac comorbid conditions.
Methods:
This population-based cohort study included residents in Ontario between 2002 and 2012 who were ≥66 years of age without known cardiovascular disease. We compared the incident risk of major adverse cardiovascular events (MACE), defined as myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, or cardiovascular death, at 1 year in patients with first-ever ischemic stroke vs propensity-matched individuals without stroke (4:1 matching using 31 variables). To estimate cause-specific hazard ratios (HRs), we used Cox regression models adjusted for variables with weighted standardized differences >0.10 or known to influence the risk of MACE.
Results:
We included 21,931 patients with first-ever ischemic stroke and 71,696 propensity-matched individuals, well balanced on all variables used for propensity matching. First-ever ischemic stroke was associated with increased unadjusted incident MACE risk (HR 4.5, 95% confidence interval [CI] 4.3-4.8). MACE adjusted risk was highest in the first 30 days (HR 25.0, 95% CI 20.5-30.5) and declined both at 31 to 90 days (HR 4.8, 95% CI 4.1-5.7) and at 91 to 365 days (HR 2.2, 95% CI 2.0-2.4).
Conclusions:
In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE. Whether this association is explained by stroke-associated cardiac injury, preexisting subclinical cardiovascular comorbid conditions, or both remains unknown.
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