Abstract 204: High Framingham Cardiovascular Risk Scores are of Prognostic Value in Recent Ischemic Stroke Patients without known Coronary Heart Disease

Abstract

Background: Stroke and myocardial infarction (MI) share similar risk factors and pathophysiological mechanisms. Ischemic stroke (IS) patients often harbor asymptomatic coronary heart disease (CHD); furthermore, beyond one month after the index stroke, they are at a higher risk of death from MI than recurrent stroke. Framingham Cardiovascular Risk Score (FCRS) is a simple, widely recognized tool for estimating 10-year risk for “hard” CHD outcomes, but its role as a prognosticator after recent stroke has not been assessed. Objectives: To determine the prevalence, predictors, and prognosis of high FCRS (≥ 20%) among recent IS patients. Methods: Analysis of a trial dataset involving 3680 recent (≤120 days) IS patients aged ≥ 35 years, recruited from 56 centers between 1996 and 2003, and followed for 2 years. We determined prevalence of high FCRS among subjects without known CHD. Association between baseline vascular risk factors and high FCRS were assessed using multivariable logistic regression. Cox models with and without competing risks were used to determine the associations between high FCRS vs. primary (stroke, MI, vascular death) and secondary (stroke) outcomes. Results: Of 2547 subjects (∼70% of cohort) who met study criteria, 37% had a high FCRS. Prior carotid endarterectomy (CEA), hypertension, and higher NIHSS, BMI, triglyceride, and LDL levels were associated with high FCRS. After adjusting for age and sex, BMI ≥30 kg/m 2 (HR 1.66, 95% CI 1.25–2.20), triglyceride level >150 mg/dL (OR 2.86, 95% CI 2.29–3.56), LDL level >100 mg/dL (OR 2.62, 95% CI 2.04–3.36), black vs. white race (OR 1.72, 95% CI 1.08–2.72) and other vs. white race (OR 1.78, 95% CI 1.31–2.43) were associated with higher odds of high FCRS, while alcohol use in the past year was associated with lower odds of high FCRS (OR 0.73, 95% CI 0.59–0.92). After adjusting for sociodemographic characteristics, vascular risk factors, stroke severity, and medication use at baseline, high FCRS was associated with a higher risk of stroke, MI or vascular death (HR 1.43, 95% CI 1.14–1.81)( Figure ). The adjusted association between high FCRS and recurrent stroke followed a similar trend, but was weaker and not significant. Conclusions: Over 1/3 of recent IS patients without known CHD have a high FCRS. High FCRS among such patients independently confers a higher risk of a major vascular event within 2 years. Using available information on history/risk profile, FCRS could be a cheap, practical, and sustainable way for clinicians to identify IS patients who may benefit from add-on CHD-specific therapies and to assess progress of major vascular risk modification.