Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
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Published on: May 22, 2019
Ann-Kathrin Ozga1, Bernhard Rauch2, Frederick Palm3
1Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. a.ozga@uke.de.
Insights
Established stroke risk factors like hypertension and diabetes do not predict death or recurrent stroke after the first event. Modern treatments appear to mitigate their long-term impact, suggesting improved post-stroke outcomes.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Biostatistics
Background:
- Stroke incidence is influenced by risk factors such as atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol.
- The prognostic impact of these risk factors on subsequent cardiovascular events or death after a first stroke requires elucidation due to advancements in modern treatment options.
Purpose of the Study:
- To investigate the persistence of adverse prognostic effects of established stroke risk diseases and risk factors on subsequent stroke or death events one year after a first stroke.
- To apply the recently introduced weighted all-cause hazard ratio for analyzing competing endpoints in post-stroke outcomes.
Main Methods:
- A 1-year follow-up study of 470 first-ever stroke cases in Ludwigshafen, Germany.
- Utilized the weighted all-cause hazard ratio to analyze competing endpoints (death and recurrent stroke).
- Extended the weighted hazard ratio approach to allow for covariate adjustment.
Main Results:
- Established risk factors and diseases (diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, smoking) were not significantly associated with subsequent death or stroke events one year post-stroke.
- Weighted hazard ratios (95% confidence intervals) for these factors ranged from 0.4 (0.2-0.9) for diabetes to 1.6 (0.8-3.6) for smoking.
- Separate analyses of death and stroke revealed variable effects of these risk factors on subsequent event rates.
Conclusions:
- Established risk factors for a first stroke do not appear to be significant predictors of subsequent death or recurrent stroke one year later, when analyzed using the weighted hazard ratio.
- The weighted all-cause hazard ratio is a valuable tool for more adequate analysis of cardiovascular risk and disease progression.
- Results warrant confirmation in larger studies with a higher number of events.
Background:
Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events 1 year after the first stroke by using the new weighted all-cause hazard ratio.
Methods:
This study evaluates the 1 year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced "weighted all-cause hazard ratio" was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.
Results:
None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2-0.9), 0.8 (0.4-2.2), 1.3 (0.5-2.5), 1.2 (0.3-2.7), 1.6 (0.8-3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.
Conclusions:
Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
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