Abstract 210: The Risk Of A Diagnosis Of Cancer After Ischemic Stroke: Two Year Follow-up Study Of 3247 Cancer Free Ischemic Stroke Patients

Abstract

Background: Subclinical cancer can manifest as a thrombo-embolic event and may be detected at a later interval in ischemic stroke survivors. Objective: To determine the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3680 adults with non-disabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. We calculated age adjusted rates of incidence of cancer among ischemic stroke survivors and calculated the standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3247 patients (mean age (±SD) of 66 (±11); 2013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 month, 1 year, and 2 years, respectively. The age adjusted annual rate of cancer in patients with ischemic stroke over 1 year after recruitment was 581.8/100,000 persons which was higher than the age adjusted cancer rate of 486.5/100,000 persons in the general population (SIR 1.2, 95% CI 1.16-1.24). The age adjusted annual rate continued to be higher in patients with ischemic stroke over 2 years after recruitment (1301.7/100,000 versus 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6). There was a higher risk for death (OR 3.1, 95% CI, 1.8-5.4), fatal/disabling stroke or death (OR 2.3, 95% CI 1.4-3.7), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age adjusted cancer incidence was higher among ischemic stroke patients compared with general population. The risk of mortality was three folds greater among stroke survivors who developed incident cancer.