Temporal Trends in Risk of Future Cardiac Events among Stroke Survivors in the United States

Abstract

Long term, stroke survivors have a higher risk of death from cardiac causes than incident stroke. However, little is known about temporal trends in age- and gender-specific risk of future cardiac events among stroke survivors. To determine temporal trends in 10-year risk of future major cardiac events (measured using the Framingham Cardiovascular Risk Score) and components of the Framingham Cardiovascular Risk Score among a nationally representative population of stroke survivors in the United States. Framingham Cardiovascular Risk Score was assessed among individuals with a self-reported history of stroke (n = 748) who participated in the National Health and Nutrition Examination Surveys in the United States during the years 1988-1994 and 1999-2006. In both National Health and Nutrition Examination Surveys waves, male stroke survivors had higher mean Framingham Cardiovascular Risk Scores than their female counterparts. This gender disparity was driven by the >64 years age group, where men had a threefold higher Framingham Cardiovascular Risk Scores compared to women (P < 0·01). Analysis of temporal trends revealed that mean Framingham Cardiovascular Risk Scores was lower in 1999-2006 compared to 1988-1994 in men (21% (standard error 1%) vs. 28% (standard error 0·2%), P = 0·01) and women (9% (standard error 1%) vs. 11% (standard error 1%), P = 0·06). Temporal comparisons revealed that diastolic blood pressure and total cholesterol levels were better in 1999-2006 compared to 1988-1994 for both genders. Male stroke survivors, particularly those over the age of 64, are at higher risk for future cardiac events than their female counterparts. For both genders, the risk of future cardiac events after stroke has declined in recent years; this reduction is most pronounced in men and likely due to improvements in blood pressure and cholesterol levels.