Abstract 4005: Longterm Survival Among Survivors Of Stroke And Myocardial Infarction In The Third National Health And Nutrition Examination Survey Mortality Follow-up Study.

Abstract

BACKGROUND: Several studies have demonstrated that the adequacy of secondary prevention is better among survivors of myocardial infarction (MI) compared with the survivors of stroke. We investigated the hypothesis that long-term survival among stroke survivors is lower than survivors of myocardial infarction. METHODS: We identified stroke and MI survivors from a nationally representative sample of 11989 US adults aged 17 to 59 years who participated in the Third National Health and Nutrition Examination Survey Mortality Follow-up Study. We compared the long-term survival between survivors of stroke and MI and those without any cardiovascular disease using Cox proportional hazards analyses. Potential confounding factors in the association between stroke and MI with death (cardiovascular and all cause) included age, sex, race/ethnicity, hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, body mass index, and alcohol use. RESULTS: A total of 485 survivors with stroke and 774 survivors with MI were included in the analysis; 74 stroke related, 128 acute MI related, and 356 ischemic heart disease related deaths and 941 all causes deaths were reported during a mean follow-up period of 8.5+/-5.3 years. After adjusting for differences in age, sex, race/ethnicity, hypertension, diabetes mellitus, cholesterol level, cigarette smoking, body mass index, and alcohol use, there was no difference among stroke survivors in likelihood of all-cause mortality (relative risk [RR], 1.1 ; 95% confidence interval [CI], 0.9 to 1.3) and cardiovascular death (RR, 0.9; 95% CI, 0.7 to 1.2) compared with persons without cardiovascular disease. CONCLUSION: Survivors of stroke face the same reduction in long-term survival as survivors of MI in the community. Therefore, proportionate efforts are required in public education and secondary prevention to improve long-term survival in these patients.