Abstract
BackgroundWe aimed to investigate the role of hypercoagulability on the risk of lifetime cardiovascular recurrences after myocardial infarction or ischaemic stroke.MethodsYoung women (< 50 years) with either myocardial infarction (n = 197) or ischaemic stroke (n = 107) were followed between 1995 and 2012 in the RATIO follow-up study. To determine whether hypercoagulability affects the risk or recurrence, a coagulation score based on acquired and inherited markers was compiled and used in a quartile analysis. Hazard ratios (HRs) obtained from Cox proportional models and adjusted for several cardiovascular risk factors were used to compare quartiles of the coagulation score for the risk of recurrence.ResultsDuring a median follow-up of 19 years, 59 cardiovascular recurrences occurred. In patients with myocardial infarction no association was found between a high prothrombotic score and recurrences (highest quartile vs lowest quartile HR 0.7, 95% CI, 0.3–1.8). Conversely, ischaemic stroke patients with a high prothrombotic score showed a doubling in risk of long-term cardiovascular recurrences (HR 1.9, 95% CI 0.6–6.3) compared with ischaemic stroke patients and low levels of the score, with a dose response relationship.ConclusionsAn increased coagulation tendency might be associated with long-term cardiovascular risk in women with ischaemic stroke, but not in women with myocardial infarction.
Highlights
We aimed to investigate the role of hypercoagulability on the risk of lifetime cardiovascular recurrences after myocardial infarction or ischaemic stroke
For the first cardiovascular event, we showed that an increased clotting propensity is a risk factor for ischaemic stroke, whereas the risk of myocardial infarction is only affected marginally [9,10,11]
The Relation to Oral Contraceptives (RATIO) follow-up study included 226 patients with myocardial infarction and 160 patients with ischemic stroke followed for a median time of 18.7 years (IQR 17.5–20.5)
Summary
We aimed to investigate the role of hypercoagulability on the risk of lifetime cardiovascular recurrences after myocardial infarction or ischaemic stroke. Young survivors of an arterial thrombotic event have an increased mortality and morbidity compared with the general population, mainly related to the high risk of cardiovascular recurrences [1,2,3]. This is important at a young age, because the impact on quality of life and on socioeconomic costs, considering life expectancy, is the highest [4, 5]. The difference in the role of coagulation in the aetiology of a first occurrence
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