In a review of short-term studies, the panel found that in the first 90 days after stroke, between 2 percent and 5 percent of stroke patients had cardiac events, many of which were fatal. Adams noted that these studies included people with established heart disease and it was unclear how many people were asymptomatic. In studies with intermediate follow-up (from one month to two years after stroke), heart attacks and cardiovascular deaths ranged from 1.5 percent to 5 percent of stroke patients, which is less common than the recurrent stroke rate.
"We conclude that up to two years after stroke, without an established history, the risk of fatal heart attack compared to having another stroke is relatively modest, but it's important and we want to take it seriously and consider testing to reduce risk in some cases," Adams said.
In long-term population studies that followed patients for up to six years, there was more significant heart disease risk that equaled or surpassed the risk for recurrent stroke, he said. Twenty-four percent to 45 percent of deaths were related to vascular disease other than stroke.
In examining stroke subtypes, people with obvious large-vessel strokes were much more likely to harbor heart disease than those with small-vessel strokes. Therefore, the authors said, doctors should make a stronger case for considering noninvasive heart disease testing in people with large-vessel disease. "This stands to reason because coronary disease is large-artery disease of the heart," he said. "They share even more closely the risk factors related to large artery disease, such as smoking and lipid abnormalities."
When it is not obvious whether a stroke is caused by large or small vessel disease, the panel recommends that doctors use the Framingham risk estimation tool. The tool calculates risk factors, such as age, gender, cholesterol, blood pressure, smoking and diabet
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
8-Sep-2003