Abstract
ObjectiveTo 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.MethodsIn 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.ResultsAmong 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).ConclusionsAs 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.
Highlights
In a population-based study in Oxfordshire, UK (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002–2014
As in older studies, patients with TIA/stroke with coexisting cardiovascular disease remain at high risk of recurrent ischemic events despite current management
Rates of use of secondary preventive therapies were high at 1-year follow-up, with similar rates of use of antithrombotics and statins in patients with and without coexisting cardiovascular disease, but rate of use of antihypertensives remained higher in those with coexisting cardiovascular disease
Summary
In a population-based study in Oxfordshire, UK (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002–2014. Study population The Oxford Vascular Study (OXVASC) is an ongoing population-based study of the incidence and outcome of all acute vascular events.[24] The study population comprised all 92,728 individuals, irrespective of age, registered with 100 family physicians in 9 general practices in Oxfordshire, UK. The analysis reported here included consecutive cases, irrespective of age, with a first TIA or ischemic stroke from April 1, 2002, to March 31, 2014, with follow-up until September 30, 2014. Information on major extracranial bleeds was only available in cases recruited from April 1, 2002, to March 31, 2012, with follow-up until March 31, 2013.
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