Thromb Haemost 2022; 122(11): 1921-1931
DOI: 10.1055/a-1873-9092
Atherosclerosis and Ischaemic Disease

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

1   Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
2   Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, St. Thomas Hospital, King's College London, London, United Kingdom
,
Barbara Iyen
1   Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
Joe Kai
1   Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
Nadeem Qureshi
1   Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
George Ntaios
3   Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
› Author Affiliations
Funding R.K.A. is funded by a National Institute for Health Research School for Primary Care Research (NIHR SPCR) PhD Studentship award. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health and Social Care.

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.

Author Contributions

R.K.A. and G.N. were involved in the study conception. Analysis was done by R.K.A. and G.G. The manuscript was drafted by R.K.A. All authors reviewed and approved the final version of the manuscript. R.K.A. is the guarantor.


Supplementary Material



Publication History

Received: 16 January 2022

Accepted: 10 June 2022

Accepted Manuscript online:
10 June 2022

Article published online:
08 September 2022

© 2022. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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