22. European Stroke Conference 5 Stroke prognosis 9:10 - 9:20 Long term risk of stroke versus acute coronary events after TIA and stroke: a popula-tion- based study N.L.M. Paul1, Z. Mehta2, L. Silver3, O.C. Geraghty4, P.M. Rothwell5 Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Univer-sity of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM3, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM4, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM5 BACKGROUND: Some preventive treatments, such as statins and antihypertensive drug class-es, differ in their relative effectiveness in preventing stroke versus coronary events. However, guidelines for secondary prevention of stroke are based partly on observations that fatal coro-nary events on long-term follow-up after TIA and stroke exceed fatal recurrent strokes. Howev-er, given the substantial fall in population incidence of coronary events in recent decades, it is uncertain whether this excess coronary risk remains. METHOD: We prospectively ascertained all TIA, minor stroke (NIHSS≤5) and major stroke in a population based study in Oxfordshire, UK, (Oxford Vascular Study, 2002-2010). Patients received best secondary prevention accord-ing to current guidelines and were followed-up face-to-face for up to 8 years. Acute coronary events included fatal and non-fatal myocardial infarction and sudden cardiac death. RESULT: Of 2035 consecutive patients with cerebrovascular events, 1928 were ischaemic (832 TIA; 778 minor stroke; 318 major stroke). Mean (SD) time to death or final follow-up was 3.1 (2.4) years, during which time there were 328 first recurrent strokes (8-year actuarial risk=24.6%, 95% CI 21.5-27.7) and 96 first acute coronary events (8-year actuarial risk=10.4%, 6.7-14.2; difference p<0.0001). The excess of recurrent stroke versus coronary events remained after exclusion of recurrences during the first 7-days: 214 vs 88 events. Death during follow-up was due to recurrent stroke in 88 patients and due to a coronary event in 42 (8-year risk: 5.4%, 12-15.2 vs 2.7%, 1.9-3.5; difference p<0.0001). CONCLUSION: The long-term risk of major vascular events after TIA and stroke remains substantial, but about 70% of fatal and non-fatal events are now accounted for by recurrent stroke rather than acute coronary events. Table 1. Baseline characteristics, previous medical history, family history, social factors, tradi-tional risk factors at index stroke and association with the combined outcome (vascular events and/or vascular death). Baseline variables and social factors Ischemic Stroke n=600 Univariate, HR (95% CI) Traditional risk factors and stro-ke subtypes Ischemic Stroke n=600 Univariate, HR (95% CI) Age, mean years (SD) 56 (10) 1.0 (1.0- 1.1)*** Hypertension, n (%) 354 (59) 1.6 (1.2- 2.2)** Male sex, n (%) 385 (64) 1.3 (1.0-1.8) Diabetes, n (%) 114 (19) 1.9 (1.4- 2.6)*** Personal history of stroke, n (%) 114 (19) 1.5 (1.0-2.0)* Hyperlipidemia, n (%) 413 (76) 1.0 (0.7-1.4) Personal history of coro-nary disease, n (%) 97 (17) 2.5 (1.8- 3.5)*** Smoking, n (%) 233 (39) 1.4 (1.0- 1.8)* Family history of stroke, n (%) 229 (41) 1.3 (1.0-1.8) WHR, mean (SD) 0.95 (0.07) 45 (4.8- 438)*** Family history of MI, n (%) 215 (38) 1.3 (0.9-1.7) TOAST subtype Living alone at index stroke, n (%) 173 (30) 1.7 (1.2- 2.3)*** SVD, n (%) 124 (21) 1 Occupation, lower educa-tion, n (%) 364 (63) 1.6 (1.2- 2.3)** LVD, n (%) 73 (12) 2.5 (1.6- 4.1)*** Self-perceived psycholog-ical stress, n (%) 126 (22) 0.78 (0.53- 1.1) Cardioembolic stroke, n (%) 98 (16) 1.9 (1.2- 3.0)** Sedentary leisure time, n (%) 108 (19) 1.3 (0.90-1.8) Cryptogenic stroke, n (%) 162 (27) 0.7 (1.0-2.4) Alcohol consumption >4 times a week, n (%) 43 (7.6) 1.6 (0.99-2.6) Other/Undeter-mined stroke, n (%) 143 (24) 1.5 (1.0-2.4) SSS at inclusion, mean score (SD) 47.5 (13) 0.99 (0.98- 1.0)** Univariate Hazard Ratios (HR) from Cox regression models were used. MI indicates myocardi-al infarction; WHR waist-to-hip ratio; SVD small vessel disease; LVD large vessel disease; SSS Scandina-vian Stroke Scale. *P<0.05, **P<0.01, ***P<0.001. 18 © 2013 S. Karger AG, Basel Scientific Programme
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