Abstract Details

Title First-ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93,627 Older Women and Men

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S37 - Stroke Epidemiology: Risk Factors, Incidence, and Unique Populations (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective We investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of first-ever ischemic stroke patients and propensity-matched individuals without stroke.

Background Stroke risk is sex-specific, but little is known about sex differences of post-stroke major adverse cardiovascular events (MACE). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in post-stroke MACE have not excluded patients with known cardiovascular comorbidities.

Design/Methods We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002−2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (myocardial infarction, unstable angina, coronary artery disease, coronary artery revascularization, congestive heart failure or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios (aHR), we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk.

Results

We included 93,627 subjects without known cardiovascular comorbidities; 21,931 with first-ever ischemic stroke and 71,696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53,476 women (12,421 with and 41,055 without ischemic stroke) and 40,151 men (9,510 with and 30,641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: aHR 25.1, 95%CI 19.3−32.6; men: aHR 23.4, 95%CI 17.2−31.9) and decreasing but remaining significant between 31−90 days (women: aHR 4.8, 95%CI 3.8−6.0; men: aHR 4.2, 95%CI 3.3−5.4), and 91−365 days (aHR 2.1, 95%CI 1.8−2.3; men: aHR 2.0, 95%CI 1.7−2.3).

Conclusions In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in women and men.

Authors/Disclosures
Luciano A. Sposato, MD (London Health Sciences Centre) PRESENTER	Dr. Sposato has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Pfizer. Dr. Sposato has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer. Dr. Sposato has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringer Ingelheim. Dr. Sposato has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Gore.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Gustavo Saposnik, MD (Director, Clinical Outcomes & Decision Neuroscience Research Centre)	Dr. Saposnik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Saposnik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIHSS. The institution of Dr. Saposnik has received research support from Roche. The institution of Dr. Saposnik has received research support from Heart and Stroke Foundation of Canada.

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