Abstract
Background and PurposeCancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke.MethodsThis was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality.ResultsAmongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76±18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54–3.80), 1.01 (1.00–1.03) and 1.35 (1.01–1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08–4.02), age (HR: 1.04, 95% CI 1.02–1.06), heart failure (HR: 3.06, 95% CI 1.72–5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02–2.36) were independent predictors for cardiovascular mortality.ConclusionsStroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
Highlights
Ischemic stroke is one of the most devastating medical conditions encountered in clinical practice and is associated with significant morbidity and mortality
We sought to investigate the risk of recurrent stroke and cardiovascular mortality with regard to cancer status in an observational study of 1,214 ischemic stroke patients
There were no significant differences in gender, proportion of ever-smokers, hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, or chronic kidney disease
Summary
Ischemic stroke is one of the most devastating medical conditions encountered in clinical practice and is associated with significant morbidity and mortality. It has been suggested that patients with cancer and ischemic stroke share common risk factors (e.g. smoking, hyperlipidemia etc.), other factors due to cancer per se (e.g. a hyper-coagulable state, treatment-related effects) may be more important in contributing to stroke after cancer [1,2]. It remains unclear whether patients with cancer and ischemic stroke are likewise at a higher risk of a recurrent stroke or cardiovascular mortality. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke
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