Comparison of risk of serious cardiovascular events after haemorrhagic versus ischaemic stroke: a population-based study.
| アブストラクト | BACKGROUND: Patients with ischaemic stroke are considered a very-high risk population for subsequent cardiovascular events and guidelines recommend intensive preventive strategies. In contrast, there is no clear recommendation that patients with haemorrhagic 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 haemorrhagic versus ischaemic stroke. METHODS: Patients aged >18 years with incident haemorrhagic or ischaemic stroke between 1998-2017, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD-GOLD) linked to Hospital Episode Statistics (HES) 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 haemorrhagic stroke had no significantly different risk of subsequent cardiovascular morbidity compared with patients with incident ischaemic stroke - CHD [HR:0.86, 95%CI:0.56-1.32], recurrent stroke [HR:0.92, 95%CI:0.83-1.02], 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 haemorrhagic stroke had significantly higher risk of subsequent 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 haemorrhagic stroke and 1,039 with ischaemic stroke showed similar risk in subsequent cardiovascular morbidity - CHD [stratified hazard ratio (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 [HR:0.71, 95%CI:0.39-1.27]. CONCLUSIONS: The risk of subsequent cardiovascular events is similar between patients with incident haemorrhagic or ischaemic stroke. Patients with previous haemorrhagic stroke should be regarded as a population at very-high risk of subsequent CVD. |
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| ジャーナル名 | Thrombosis and haemostasis |
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| 投稿日 | 2022/6/11 |
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| 投稿者 | Akyea, Ralph Kwame; Georgiopoulos, Georgios; Iyen, Barbara; Kai, Joe; Qureshi, Nadeem; Ntaios, George |
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| 組織名 | Centre for Academic Primary Care, University of Nottingham, Nottingham, United;Kingdom of Great Britain and Northern Ireland.;National and Kapodistrian University of Athens School of Medicine Therapeutic;Clinic, Athens, Greece.;School of Biomedical Engineering and Imaging Sciences,, King's College London,;London, United Kingdom of Great Britain and Northern Ireland.;Department of Medicine, University of Thessaly, Larissa, Greece. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35688459/ |
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