Abstract TP185: Framingham Score Predicts Short-Term Risk of Major Clinical Events after a Recent Stroke

Abstract

Background: Identifying patients with a recent stroke at high risk for future major vascular events may provide opportunities to improve clinical outcomes. Although Framingham Coronary Risk Score (FCRS) predicts major coronary events over 10 years in the general population free of symptomatic vascular disease, few studies have examined its role as a prognosticator after stroke. We assessed the link between the baseline FCRS and major clinical events among patients with a recent stroke. Methods: We analyzed data on ischemic stroke patients enrolled in a randomized quality improvement trial of secondary stroke prevention, conducted in 14 Kaiser Permanente hospitals in Northern California between January 2004 and September 2006. Electronic records from the index hospitalization and for 6 months following hospitalization were reviewed. Framingham Risk Scores (FRS) were calculated for each patient but all patients >74 years of age (the upper age limit included in the FRS) were excluded from the analysis. FRS scores were dichotomized into high (≥20%) and low (<20%) risk according to gender guidelines. The primary outcome was recurrent stroke, myocardial infarction and all-cause mortality after hospital discharge; and secondary outcomes were any stroke and any MI. Analyses were adjusted for age, gender, race, BMI, serum lipid levels, and discharge prescription of antithrombotics and statins. Results: Among 1667 patients discharged alive, mean age was 62.9 (8.6), 46% were male, 58% white, 32% had high FCRS. In adjusted analyses, high FCRS scores were associated with Black race (vs. White), higher BMI, and elevated serum triglycerides. Compared to those with low FCRS, high FCRS was associated with higher odds of the composite primary outcome 1.50 (1.16-1.93, p=0.002) and any recurrent stroke 1.53 (95% CI 1.18-1.98, p=0.001), but not any MI 1.14(95% CI 0.42-3.14, p=0.79). Additionally adjusting for age slightly attenuated these results, but did not change the significance level. A low incidence of MI (12 cases) resulted in a lack of power for this outcome. Conclusions: A baseline FRCS>20% predicts higher short-term risk of major clinical events in recent ischemic stroke patients.