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

被引：15

作者：

Boulanger, Marion ^{[1
,2
]}

Li, Linxin ^{[1
]}

Lyons, Shane ^{[1
]}

Lovett, Nicola G. ^{[1
]}

Kubiak, Magdalena M. ^{[1
]}

Silver, Louise ^{[1
]}

Touze, Emmanuel ^{[2
]}

Rothwell, Peter M. ^{[1
]}

Pendlebury, Sarah ^{[3
]}

Kuker, Wilhelm ^{[3
]}

Webb, Alastair ^{[3
]}

Mazzucco, Sara ^{[3
]}

Yiin, Gabriel ^{[3
]}

Tuna, Maria ^{[3
]}

Howard, Dominic ^{[3
]}

Luengo-Fernandez, Ramon ^{[3
]}

Binney, Lucy ^{[3
]}

Mehta, Ziyah ^{[3
]}

Gutnikov, Sergei ^{[3
]}

Brooks, Jean ^{[3
]}

McColl, Aubretia ^{[3
]}

McGurgan, Iain ^{[3
]}

Hurford, Robert ^{[3
]}

Kelly, Dearbhla ^{[3
]}

Welch, Sarah ^{[3
]}

McCulloch, Ellen ^{[3
]}

Beebe, Sally ^{[3
]}

Bowsher-Brown, Karen ^{[3
]}

Brooks, Josephine ^{[3
]}

Rae, Susannah ^{[3
]}

Vaughan-Fowler, Emily-Rose ^{[3
]}

Harris, Robyn ^{[3
]}

Haigh, Anne-Marie ^{[3
]}

Wilson, Michelle ^{[3
]}

Cuthbertson, Fiona ^{[3
]}

Lawson, Amy ^{[3
]}

Burgess, Annette ^{[3
]}

Poole, Deborah ^{[3
]}

Duerden, Julia ^{[3
]}

Green, Debbie ^{[3
]}

Drummond, Maria ^{[3
]}

机构：

[1] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Clin Neurosci, Ctr Prevent Stroke & Dementia, Oxford, England

[2] Normandie Univ, CHU Caen Normandie, Serv Neurol, UNICAEN,INSERM,U1237, Caen, France

[3] Univ Oxford, Ctr Prevent Stroke & Dementia, Oxford, England

来源：

NEUROLOGY | 2019年 / 93卷 / 07期

基金：

英国惠康基金;

关键词：

PATENT FORAMEN OVALE; CARDIOVASCULAR EVENTS; ISCHEMIC-STROKE; MYOCARDIAL-INFARCTION; UNDETERMINED SOURCE; COST-EFFECTIVENESS; EUROPEAN-SOCIETY; RANDOMIZED-TRIAL; DOUBLE-BLIND; PREVENTION;

D O I：

10.1212/WNL.0000000000007935

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective To determine whether patients with TIA or ischemic stroke with coexisting cardiovascular disease (i.e., history of coronary or peripheral artery disease) are still at high risk of recurrent ischemic events despite current secondary prevention guidelines. Methods In a population-based study in Oxfordshire, UK (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002-2014. Patients were treated according to current secondary prevention guidelines and we determined risks of coronary events, recurrent ischemic stroke, and major bleeding stratified by the presence of coexisting cardiovascular disease. Results Among 2,555 patients (9,148 patient-years of follow-up), those (n = 640; 25.0%) with coexisting cardiovascular disease (449 coronary only; 103 peripheral only; 88 both) were at higher 10-year risk of coronary events than those without (22.8%, 95% confidence interval 17.4-27.9; vs 7.1%, 5.3-8.8; p < 0.001; age- and sex-adjusted hazard ratio [HR] 3.07, 2.24-4.21) and of recurrent ischemic stroke (31.5%, 25.1-37.4; vs 23.4%, 20.5-26.2; p = 0.0049; age- and sex-adjusted HR 1.23, 0.99-1.53), despite similar rates of use of antithrombotic and lipid-lowering medication. However, in patients with noncardioembolic TIA/stroke, risk of extracranial bleeds was also higher in those with coexisting cardiovascular disease, particularly in patients aged <75 years (8.1%, 2.8-13.0; vs 3.4%, 1.6-5.3; p = 0.0050; age- and sex-adjusted HR 2.71, 1.16-6.30), although risk of intracerebral hemorrhage was not increased (age- and sex-adjusted HR 0.36, 0.04-2.99). Conclusions As in older studies, patients with TIA/stroke with coexisting cardiovascular disease remain at high risk of recurrent ischemic events despite current management. More intensive lipid-lowering might therefore be justified, but benefit from increased antithrombotic treatment might be offset by the higher risk of extracranial bleeding.

引用

页码：E695 / E707

页数：13

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