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Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based Study

Akyea, Ralph K.; Georgiopoulos, Georgios; Iyen, Barbara; Kai, Joe; Qureshi, Nadeem; Ntaios, George

Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based Study Thumbnail


Authors

Georgios Georgiopoulos

BARBARA IYEN Barbara.Iyen2@nottingham.ac.uk
Clinical Associate Professor in Primary Care

George Ntaios



Abstract

Background Patients with ischemic stroke are considered a very high risk population for subsequent cardiovascular events and guidelines recommend intensive preventive strategies. However, there is no clear recommendation that patients with hemorrhagic stroke should also be regarded as a very high cardiovascular risk population. Objective To compare the risk of subsequent cardiovascular morbidity/mortality between patients with incident hemorrhagic and ischemic stroke. Methods Patients aged ≥18 years with incident hemorrhagic or ischemic stroke between 1998 and 2017 and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics data. Results The cohort included 32,091 patients with an overall follow-up of 381,237 person-years (median: 11.8 years). After adjusting for potential confounders, patients with incident hemorrhagic stroke had no significantly different risk of subsequent cardiovascular morbidity compared with patients with incident ischemic stroke-coronary heart disease (CHD; hazard ratio [HR]: 0.86, 95% confidence interval [CI]: 0.56-1.32), recurrent stroke (HR: 0.92, 95% CI: 0.83-1.02), peripheral vascular disease (PVD; HR: 1.15, 95% CI:0.56-2.38), or heart failure (HR: 1.03, 95% CI: 0.61-1.74). Patients with incident hemorrhagic stroke had significantly higher risk of subsequent cardiovascular disease (CVD)-related mortality (HR: 2.35, 95% CI: 2.04-2.72) and all-cause mortality (HR: 2.16, 95% CI: 1.94-2.41). Propensity-score matched analysis of 1,039 patients with hemorrhagic stroke and 1,039 with ischemic stroke showed similar risk in subsequent cardiovascular morbidity-CHD (stratified HR [sHR]: 0.92, 95% CI: 0.55-1.54), recurrent stroke (sHR: 0.93, 95% CI: 0.82-1.02), PVD (sHR: 1.04 95% CI: 0.45-2.41), or heart failure (sHR: 0.71, 95% CI: 0.39-1.27). Conclusion The risk of subsequent cardiovascular events is similar between patients with incident hemorrhagic and ischemic stroke. Patients with previous hemorrhagic stroke should be regarded as a population at very high risk for subsequent CVD.

Citation

Akyea, R. K., Georgiopoulos, G., Iyen, B., Kai, J., Qureshi, N., & Ntaios, G. (2022). Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based Study. Thrombosis and Haemostasis, 122(11), 1921-1931. https://doi.org/10.1055/a-1873-9092

Journal Article Type Article
Acceptance Date Jun 7, 2022
Online Publication Date Jun 10, 2022
Publication Date 2022-11
Deposit Date Jul 18, 2022
Publicly Available Date Jun 11, 2023
Journal Thrombosis and Haemostasis
Print ISSN 0340-6245
Electronic ISSN 2567-689X
Publisher Schattauer
Peer Reviewed Peer Reviewed
Volume 122
Issue 11
Pages 1921-1931
DOI https://doi.org/10.1055/a-1873-9092
Keywords Hematology
Public URL https://nottingham-repository.worktribe.com/output/8501779
Publisher URL https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-1873-9092

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