The American Journal of Medicine
Volume 122, Issue 4, Supplement 2 , Pages S7-S13 , April 2009

Outcomes After Stroke: Risk of Recurrent Ischemic Stroke and Other Events

  • Mitchell S.V. Elkind, MD, MS

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Mitchell S.V. Elkind, MD, MS, Department of Neurology, Division of Stroke and Critical Care, Columbia University College of Physicians and Surgeons, 710 West 168th Street, Room 641, New York, New York 10032

References 

  1. Rosamond W, Flegal K, Furie K, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–e146
  2. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction: the Northern Manhattan Stroke Study. Stroke. 1995;26:14–20
  3. Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet. 1995;346:1647–1653
  4. Tirschwell DL, Smith NL, Heckbert SR, Lemaitre RN, Longstreth WT, Psaty BM. Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology. 2004;63:1868–1876
  5. Hartmann A, Rundek T, Mast H, et al. Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study. Neurology. 2001;57:2000–2005
  6. Dhamoon MS, Sciacca RR, Rundek T, Sacco RL, Elkind MS, et al. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006;66:641–646
  7. Vernino S, Brown RD, Sejvar JJ, Sicks JD, Petty GW, O'Fallon WM, et al. Cause-specific mortality after first cerebral infarction: a population-based study. Stroke. 2003;34:1828–1832
  8. Prencipe M, Culasso F, Rasura M, et al. Long-term prognosis after a minor stroke: 10-year mortality and major stroke recurrence rates in a hospital-based cohort. Stroke. 1998;29:126–132
  9. Peltonen M, Stegmayr B, Asplund K. Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994. Stroke. 1998;29:1358–1365
  10. Brønnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke. 2001;32:2131–2136
  11. Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke. 2000;31:2080–2086
  12. Ross GW, Petrovitch H, White LR, et al. Characterization of risk factors for vascular dementia: the Honolulu-Asia Aging Study. Neurology. 1999;53:337–343
  13. Tatemichi TK, Desmond DW, Paik M, et al. Clinical determinants of dementia related to stroke. Ann Neurol. 1993;33:568–575
  14. Hillen T, Coshall C, Tilling K, et al. Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke. 2003;34:1457–1463
  15. Hankey GJ. Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis. 2003;16(suppl 1):14–19
  16. Mohr JP, Thompson JL, Lazar RM, et al. Warfarin-Aspirin Recurrent Stroke Study Group A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444–1451
  17. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305–1316
  18. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991;325:445–453
  19. Lai SM, Alter M, Friday G, Sobel E. A multifactorial analysis of risk factors for recurrence of ischemic stroke. Stroke. 1994;25:958–962
  20. Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A, et al. European Stroke Prevention Study 2 (Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke). J Neurol Sci. 1996;143:1–13
  21. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–1339
  22. Vickrey BG, Rector TS, Wickstrom SL, et al. Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease. Stroke. 2002;33:901–906
  23. Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ. 2002;324:1570–1576
  24. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–774
  25. Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–2572
  26. Rose G. The Strategy of Preventive Medicine. Oxford, England: Oxford University Press; 1992;
  27. Diener HC, Sacco R, Yusuf S Steering Committee of the PRoFESS Study Group. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes Trial (PRoFESS). Cerebrovasc Dis. 2007;23:368–380
  28. Adams RJ, Chimowitz MI, Alpert JS, et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation. 2003;108:1278–1290
  29. Dexter DD, Whisnant JP, Connolly DC, O'Fallon WM. The association of stroke and coronary heart disease: a population study. Mayo Clin Proc. 1987;62:1077–1083
  30. Viitanen M, Eriksson S, Asplund K. Risk of recurrent stroke, myocardial infarction and epilepsy during long-term follow-up after stroke. Eur Neurol. 1988;28:227–231
  31. Dhamoon MS, Tai W, Boden-Albala B, et al. Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan Study. Stroke. 2007;38:1752–1758
  32. Petty G, Brown RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975-1989. Neurology. 1998;50:208–216
  33. Hass WK, Easton JD, Adams HP, et al. Randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med. 1989;321:501–507
  34. Hass WK, Molony BA, Anderson S, Kamm B. Comparison of ticlopidine and aspirin for the prevention of stroke. N Engl J Med. 1990;322:400
  35. Matias-Guiu J, Ferro JM, Alvarez-Sabin J, et al. TACIP Investigators Comparison of triflusal and aspirin for prevention of vascular events in patients after cerebral infarction: the TACIP Study—a randomized, double-blind, multicenter trial. Stroke. 2003;34:840–848
  36. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet. 2001;358:1033–1041
  37. Diener HC, Forbes C, Riekkinen PJ, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study 2: efficacy and safety data. 6. Secondary endpoints. J Neurol Sci. 1997;151:527–537
  38. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360:7–22
  39. Salgado AV, Ferro JM, Gouveia-Oliveira A. Long-term prognosis of first-ever lacunar strokes: a hospital-based study. Stroke. 1996;27:661–666
  40. Gorelick PB, Richardson D, Kelly M, et al. African American Antiplatelet Stroke Prevention Study Investigators Aspirin and ticlopidine for prevention of recurrent stroke in black patients: a randomized trial. JAMA. 2003;289:2947–2957
  41. Samuelsson M, Lindell D, Norrving B. Presumed pathogenetic mechanisms of recurrent stroke after lacunar infarction. Cerebrovasc Dis. 1996;6:128–136
  42. Loeb C, Gandolfo C, Bino G. Intellectual impairment and cerebral lesions in multiple cerebral infarcts: a clinical-computed tomography study. Stroke. 1988;19:560–565
  43. Miyao S, Takano A, Teramoto J, Takahashi A. Leukoaraiosis in relation to prognosis for patients with lacunar infarction. Stroke. 1992;23:1434–1438
  44. Bousser MG, Eschwege E, Haguenau M, et al. “AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke. 1983;14:5–14
  45. Gamaldo A, Moghekar A, Kilada S, Resnick SM, Zonderman AB, O'Brien R. Effect of a clinical stroke on the risk of dementia in a prospective cohort. Neurology. 2006;67:1363–1369
  46. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215–1222
  47. Howard G, Safford MM, Meschia JF, et al. Stroke symptoms in individuals reporting no prior stroke or transient ischemic attack are associated with a decrease in indices of mental and physical functioning. Stroke. 2007;38:2446–2452
  48. Breteler MM. Vascular risk factors for Alzheimer's disease: an epidemiologic perspective. Neurobiol Aging. 2000;21:153–160
  49. Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease: the Nun Study. JAMA. 1997;277:813–817
  50. Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology. 2005;64:494–500
  51. Luchsinger JA, Reitz C, Honig LS, Tang MX, Shea S, Mayeux R. Aggregation of vascular risk factors and risk of incident Alzheimer disease. Neurology. 2005;65:545–551
  52. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330–1340
  53. House A, Dennis M, Mogridge L, Warlow C, Hawton K, Jones L. Mood disorders in the year after first stroke. Br J Psychiatry. 1991;158:83–92
  54. Kase CS, Wolf PA, Kelly-Hayes M, Kannel WB, Beiser A, D'Agostino RB. Intellectual decline after stroke: the Framingham Study. Stroke. 1998;29:805–812
  55. Robinson RG, Shoemaker WJ, Schlumpf M, Valk T, Bloom FE. Effect of experimental cerebral infarction in rat brain on catecholamines and behaviour. Nature. 1975;255:332–334
  56. Bhogal SK, Teasell R, Foley N, Speechley M. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke. 2004;35:794–802
  57. Hackett ML, Anderson CS. Predictors of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:2296–2301
  58. Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA. 2008;299:2391–2400
  59. Hackett ML, Anderson CS, House AO. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke. 2005;36:1098–1103
  60. Pambianco G, Orchard T, Landau P. Deep vein thrombosis: prevention in stroke patients during rehabilitation. Arch Phys Med Rehabil. 1995;76:324–330
  61. Warlow C, Ogston D, Douglas AS. Deep vein thrombosis of the leg after stroke: part I—incidence and predisposing factors. BMJ. 1976;1:1178–1181
  62. Warlow C, Ogston D, Douglas AS. Deep venous thrombosis of the legs after strokes: part II—natural history. BMJ. 1976;1:1181–1183
  63. Sherman DG, Albers GW, Bladin C, et al. The efficacy and safety of enoxaparin and unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL study): an open-label randomised comparison. Lancet. 2007;369:1347–1355
  64. Miyamoto AT, Miller LS. Pulmonary embolism in stroke: prevention by early heparinization of venous thrombosis detected by iodine-125 fibrinogen leg scans. Arch Phys Med Rehabil. 1980;61:584–587
  65. Bromfield EB, Reding MJ. Relative risk of deep venous thrombosis or pulmonary embolism post-stroke based on ambulatory status. Neurorehabilitation and Neural Repair. 1988;2:51–57
  66. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284:2901–2906
  67. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497
  68. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239
  69. Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. Circulation. 1999;100:1481–1492
  70. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389
  71. Plehn JP, Davis BR, Sacks FM, et al. CARE Investigators Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study. Circulation. 1999;99:216–223
  72. Byington RP, Davis BR, Plehn JP, et al. Reduction of stroke events with pravastatin: the Prospective Pravastatin Pooling (PPP) Project. Circulation. 2001;103:387–392
  73. Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20,536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363:757–767
  74. Sacks FM, Tonkin AM, Shepherd J, et al. Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: the Prospective Pravastatin Pooling Project. Circulation. 2000;102:1893–1900
  75. De Backer G, Ambrosioni E, Borch-Johnsen K, et al. Third Joint Force of European and other Societies on Cardiovascular Disease and Prevention in Clinical Practice European guidelines on cardiovascular disease and prevention in clinical practice. Atherosclerosis. 2003;171:145–155
  76. Amarenco P, Bogouss Lavsky J, Callahan A, et al. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–559
  77. US Food and Drug Administration. FDA announces labeling changes on heart benefit associated with cholesterol drug Zocor. [FDA Website.] FDA Talk Paper T03-27. April 16, 2003 www.fda.gov/bbs/topics/ANSWERS/2003/ANS01213.htmlAccessed August 20, 2007
  78. Yusuf S, Sleigh P, Pogue J, Bosch J, Davies R, Dagenais G The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–153
  79. Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study. A randomized controlled trial. JAMA. 2004;292:2217–2225

 Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

PII: S0002-9343(09)00139-9

doi: 10.1016/j.amjmed.2009.02.005

The American Journal of Medicine
Volume 122, Issue 4, Supplement 2 , Pages S7-S13 , April 2009

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