Patients maintained a 3-fold increased risk of recurrent stroke and a nearly 2-fold increased risk of dementia beyond 1 year poststroke compared to patients without stroke, according to data published in Stroke.

Marileen L.P. Portegies, MD, of the Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues sought to determine the long-term hazards after a first stroke survival. They chose 1237 patients with a first stroke and matched them to 4928 stroke-free patients based on selection date, age, sex, and visit to the same examination round.

The risk for recurrent stroke and dementia risk was highest in the short-term, but continued to increase beyond the first year (incidence rate ratio: 3.16; 95% confidence interval [CI]: 2.59-3.85 and 1.73; 95% CI: 1.38-2.17, respectively). Dr Portegies and colleagues noted that these differences were only statistically significant from years 1 to 5.


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Importantly, patients who experienced stroke had worse cardiovascular profiles than those without stroke. Hypertension, low high-density lipoprotein cholesterol, diabetes, smoking, and transient ischemic attack were among the main factors that contributed to a recurrent stroke.

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“The total population attributable risk for all risk factors combined was similar in people with stroke (0.39 [0.18-0.66]) compared with those without (0.39 [0.24-0.57]),” the authors wrote.

There were no significant associations of prestroke cardiovascular risk factors with dementia which resulted in a low population attributable risk of 0.10 (0.001-0.91) in patients with stroke vs 0.09 (0.02-0.37) in those without.

“Prestroke cardiovascular risk factors contribute to 39% of recurrent strokes and 10% of poststroke dementia cases. Taken together, this emphasizes the need of optimizing both primary and secondary preventions,” researchers concluded.

Reference

Portegies MLP, Wolters FJ, Hofman A, Ikram MK, Koudstaal PJ, Ikram MA. Prestroke vascular pathology and the risk of recurrent stroke and poststroke dementia. Stroke. 2016;47. doi: 10.1161/STROKEAHA.116.014094.