Poor functional status based on the New York Heart Association classification exposes the coronary patient to an elevated risk of ischemic stroke

Abstract

Patients with coronary heart disease (CHD) are at increased risk of stroke. We investigated in a large cohort of patients with CHD the relationship between functional status, as assessed by the New York Heart Association (NYHA) classification, and incident ischemic stroke. We followed up 15,524 patients with documented CHD, screened for inclusion in a clinical trial (Bezafibrate Infarction Prevention), for 4.8 to 8.1 years. Functional status at baseline was categorized according to the NYHA classification. Among 14,703 patients, free of stroke, with recorded NYHA functional class, 1086 (7.4%) developed an ischemic cerebrovascular event, of whom 604 (4.1%) patients were confirmed to have an ischemic stroke or transient ischemic attack. The cumulative rate of ischemic cerebrovascular events increased from 6.7% in patients with NYHA functional class I to 9.2% and 9.7% for patients with NYHA functional classes II and III, respectively (P < .001). Adjustments were made in Cox proportional hazard models for age, sex, body mass index, past myocardial infarction, current smoking, diabetes, hypertension, peripheral vascular disease, percent of cholesterol in high-density lipoprotein, and triglyceride levels. The adjusted hazard ratios associated with NYHA functional class II and III were 1.29 (95% confidence interval 1.12-1.48) and 1.71 (95% confidence interval 1.36-2.15), respectively, as compared with patients with NYHA class I. Our findings indicate that stable coronary patients with even a slight limitation based on the NYHA functional class are exposed to an increased risk of ischemic stroke.