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Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based

Ralph K Akyea1, Georgios Georgiopoulos2, Barbara Iyen1

  • 1Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom.

Thrombosis and Haemostasis
|June 10, 2022
PubMed

Insights

Patients with hemorrhagic stroke face a similar risk of subsequent cardiovascular events as those with ischemic stroke. This finding suggests that individuals with a history of hemorrhagic stroke should be considered high-risk for future cardiovascular disease (CVD).

Area of Science:

  • Cardiovascular epidemiology
  • Neurology
  • Public health

Background:

  • Ischemic stroke patients are high-risk for cardiovascular events, necessitating intensive preventive strategies.
  • Current guidelines lack clear recommendations for considering hemorrhagic stroke patients as high-risk for cardiovascular disease.

Purpose of the Study:

  • To compare the risk of subsequent cardiovascular morbidity and mortality between patients who have experienced hemorrhagic stroke versus ischemic stroke.

Main Methods:

  • Utilized UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics data.
  • Identified patients aged 18 years or older with incident hemorrhagic or ischemic stroke between 1998 and 2017, excluding those with prior serious vascular events.
  • Followed a cohort of 32,091 patients for a median of 11.8 years (381,237 person-years).

Main Results:

  • Adjusted analyses revealed no significant difference in the risk of subsequent cardiovascular morbidity (coronary heart disease, recurrent stroke, peripheral vascular disease, heart failure) between hemorrhagic and ischemic stroke groups.
  • Patients with hemorrhagic stroke exhibited a significantly higher risk of cardiovascular disease-related mortality (HR: 2.35) and all-cause mortality (HR: 2.16) compared to ischemic stroke patients.
  • Propensity-score matched analysis confirmed similar risks for cardiovascular morbidity outcomes.

Conclusions:

  • The risk of subsequent cardiovascular events is comparable between patients with incident hemorrhagic and ischemic stroke.
  • Patients with a history of hemorrhagic stroke should be recognized as a very high-risk population for subsequent cardiovascular disease (CVD).
Abstract

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