Abstract
BackgroundRisk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events 1 year after the first stroke by using the new weighted all-cause hazard ratio.MethodsThis study evaluates the 1 year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.ResultsNone of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2–0.9), 0.8 (0.4–2.2), 1.3 (0.5–2.5), 1.2 (0.3–2.7), 1.6 (0.8–3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.ConclusionsUsing the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
Highlights
Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol
A recent meta-analysis suggested that hypertension, diabetes mellitus, atrial fibrillation, and coronary heart disease might be risk factors for a subsequent stroke occurrence, they did not consider a time-to-event analysis [10]
To analyze the risk factors that might affect the time to death or subsequent stroke we applied the weighted all-cause hazard ratio, thereby taking into account the occurrence of competing events [13, 14]
Summary
Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Known risk factors and risk diseases for a first ever stroke like atrial fibrillation, hypertension, diabetes mellitus, smoking, or high cholesterol are well accepted of being responsible for about 50– 70% of all strokes [5, 6]. Risk factors for subsequent strokes after a first non-fatal stroke event were analyzed but more heterogeneous results were gained with indicators including diabetes mellitus, coronary artery disease, hypertension, a high baseline score on the “National Institute of Health Stroke Scale”, intracranial arterial stenosis, or hyperlipidemia [7,8,9]. There are extended efforts in medical research to prevent subsequent strokes after a first stroke, thereby continuously changing risk patterns in secondary prevention [12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
