Risk factors for death by acute ischaemic stroke in patients from West-Pomerania, Poland
Abstract
Aim and clinical rationale for study. In Poland, it is widely believed that the outlook for ischaemic stroke patients is gradually improving due to the development of a network of stroke wards and other dedicated hospital units throughout the country. However, a study by Shah et al., reporting a significant increase in mortality from ischaemic stroke in several European countries including Poland, contradicts this belief. Therefore, the aim of this study was to determine the risk factors for death in patients with recent ischaemic stroke among a population of patients from Western Pomerania, a region in north-western Poland.
Materials and methods. This retrospective study involved 2,374 patients with recent ischaemic stroke. Mortality was defined as death within 30 days of admission to hospital. Patients who died in hospital during this period were defined as deceased, while those who survived beyond this time were classified as alive.
Results. We found that compared to ischaemic stroke patients who survived, the group of ischaemic stroke patients who died included a higher number of patients who smoked cigarettes (OR = 6.08 in univariable model; OR = 6.22 in adjusted model), had hypertension (OR = 2.57; OR = 1.85), had a history of previous stroke (OR = 2.63; OR = 2.14), had coronary heart disease (OR = 1.78; OR=1.36), and were older (OR = 1.06; OR = 1.05). For all these factors, p-value was lower than 0.001. Females had a higher risk of death (OR = 1.48, p < 0.001; OR = 1.35, p = 0.01). For dyslipidemia, only univariable model was statistically
significant (OR = 1.38, p < 0.001).
Conclusion and clinical implications. Older age, female sex, dyslipidemia, hypertension, coronary heart disease, and smoking are not only recognised risk factors for ischaemic stroke, but also risk factors associated with an unfavourable prognosis following stroke.
Keywords: ischaemic strokerisk factorsdeathPoland
References
- Xu XM, Vestesson E, Paley L, et al. The economic burden of stroke care in England, Wales and Northern Ireland: Using a national stroke register to estimate and report patient-level health economic outcomes in stroke. Eur Stroke J. 2018; 3(1): 82–91.
- Timmis A, Townsend N, Gale C, et al. ESC Scientific Document Group. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018; 39(7): 508–579.
- Wallin M, Culpepper W, Nichols E, et al. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019; 18(3): 269–285.
- Shah R, Wilkins E, Nichols M, et al. Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. Eur Heart J. 2019; 40(9): 755–764.
- Tahrani AA, Bailey CJ, Del Prato S, et al. Management of type 2 diabetes: new and future developments in treatment. Lancet. 2011; 378(9786): 182–197.
- Grundy S, Cleeman J, Merz C, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004; 24(8).
- Mansia G, De Backer G, Dominiczak A, et al. European Society of Hypertension, European Society of Cardiology, Management of Arterial Hypertension of the European Society of Hypertension, European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007; 28(12): 1462–1536.
- Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 2000; 342(23): 1693–1700.
- Halliday A, Harrison M, Hayter E, et al. Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010; 376(9746): 1074–1084.
- Williams B, Mancia G, Spiering W, et al. List of authors/Task Force members:, Authors/Task Force Members:. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953–2041.
- Kuller LH. Epidemiology and prevention of stroke, now and in the future. Epidemiol Rev. 2000; 22(1): 14–17.
- Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349): 1903–1913.
- Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991; 265(24): 3255–3264.
- Staessen JA, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999; 282(6): 539–546.
- Lackland DT, Egan BM, Mountford WK, et al. Thirty-year Survival for Black and White Hypertensive Individuals in the Evans County Heart Study and the Hypertension Detection and Follow-up Program. J Am Soc Hypertens. 2008; 2(6): 448–454.
- Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989; 298(6676): 789–794.
- Mannami T, Iso H, Baba S, et al. Japan Public Health Center-Based Prospective Study on Cancer and Cardiovascular Disease Group. Cigarette smoking and risk of stroke and its subtypes among middle-aged Japanese men and women: the JPHC Study Cohort I. Stroke. 2004; 35(6): 1248–1253.
- Kuller LH, Ockene JK, Meilahn E, et al. Cigarette smoking and mortality. MRFIT Research Group. Prev Med. 1991; 20(5): 638–654.
- Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. JAMA. 2000; 284(6): 706–712.
- Towfighi A, Markovic D, Ovbiagele B. Impact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the USA. J Neurol Neurosurg Psychiatry. 2012; 83(2): 146–151.
- Oza R, Rundell K, Garcellano M. Recurrent Ischemic Stroke: Strategies for Prevention. Am Fam Physician. 2017; 96(7): 436–440.
- Hardie K, Jamrozik K, Hankey GJ, et al. Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community Stroke Study. Cerebrovasc Dis. 2005; 19(3): 179–185.
- Peltonen M, Stegmayr B, Asplund K. Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994. Stroke. 1998; 29(7): 1358–1365.
- Vernino S, Brown RD, Sejvar JJ, et al. Cause-specific mortality after first cerebral infarction: a population-based study. Stroke. 2003; 34(8): 1828–1832.
- Brown DL, Lisabeth LD, Roychoudhury C, et al. Recurrent stroke risk is higher than cardiac event risk after initial stroke/transient ischemic attack. Stroke. 2005; 36(6): 1285–1287.
- Allen NB, Holford TR, Bracken MB, et al. Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. Neuroepidemiology. 2010; 34(2): 123–129.
- Broderick JP, Phillips SJ, O'Fallon WM, et al. Relationship of cardiac disease to stroke occurrence, recurrence, and mortality. Stroke. 1992; 23(9): 1250–1256.
- Gunnoo T, Hasan N, Khan MS, et al. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants. BMJ Open. 2016; 6(1): e009535.
- Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7(10): 915–926.
- Saposnik G, Cote R, Phillips S, et al. Stroke Outcome Research Canada (SORCan) Working Group. Stroke outcome in those over 80: a multicenter cohort study across Canada. Stroke. 2008; 39(8): 2310–2317.
- Persky RW, Turtzo LC, McCullough LD. Stroke in women: disparities and outcomes. Curr Cardiol Rep. 2010; 12(1): 6–13.
- Tuttolomondo A, Di Raimondo D, Di Sciacca R, et al. Effects of clinical and laboratory variables at admission and of in-hospital treatment with cardiovascular drugs on short term prognosis of ischemic stroke. The GIFA study. Nutr Metab Cardiovasc Dis. 2013; 23(7): 642–649.
- Jain M, Jain A, Yerragondu N, et al. The Triglyceride Paradox in Stroke Survivors: A Prospective Study. Neurosci J. 2013; 2013: 870608.
- Koton S, Schneider ALC, Rosamond WD, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014; 312(3): 259–268.
- Lu Da, Li P, Zhou Y, et al. Association between serum non-high-density lipoprotein cholesterol and cognitive impairment in patients with acute ischemic stroke. BMC Neurol. 2016; 16(1): 154.
- Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017; 120(3): 472–495.
- Pol T, Held C, Westerbergh J, et al. Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial. J Am Heart Assoc. 2018; 7(3).