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(Stroke. 2007;38:1713.)
© 2007 American Heart Association, Inc.

Editorials

Should Stroke Be Considered Both a Brain Attack and a Heart Attack?

Seemant Chaturvedi, MD, FAHA, FAAN

From the Department of Neurology and Stroke Program, Wayne State University, Detroit, Mich.

Correspondence to Seemant Chaturvedi, MD, Department of Neurology & Stroke Program, Wayne State University, 8C-UHC, 4201 St. Antoine, Detroit, MI 48201. E-mail SChaturv@med.wayne.edu

Key Words: cardiac disease • statins

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1752–1758.

The concept of coronary risk equivalents has gained increased acceptance in recent years. In the 2001 National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines, diabetes mellitus, peripheral arterial disease, abdominal aortic aneurysm, and "symptomatic carotid artery disease" were cited as coronary risk equivalents.¹ These conditions carry a 10-year risk of coronary heart disease events of >20%.

In 2004, the tent containing coronary risk equivalent conditions was expanded by the NCEP committee to symptomatic carotid disease or ">50% obstruction of a carotid artery."² In addition, whereas in 2001, the low-density lipoprotein target for coronary risk equivalents was <100 mg/dL, in 2004, an optional target of <70 mg/dL was established for high-risk patients.

In this issue of Stroke, Dhamoon et al, using data from the Northern Manhattan Study, provide further ammunition to support the enlargement of the coronary risk equivalent umbrella.³ These authors followed 655 patients (aged 40 years or older) with a first ischemic stroke for a 5-year period. In their overall population, the 5-year risk of myocardial infarction (MI) or vascular death (VD) was 17.4%. There was an increased "up front" risk of 8.2% at one year. Their study also identified age >70 years, history of coronary artery disease, and atrial fibrillation as independent predictors of MI or VD. Embolic stroke subtype was particularly ominous, whereas lacunar stroke subtype was less risky. The 5-year risk of MI or VD was 11.5% in patients aged 70 years and over with lacunar infarcts, . . . [Full Text of this Article]

Related Article:

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke: The Northern Manhattan Study

Mandip S. Dhamoon, Wanling Tai, Bernadette Boden-Albala, Tanja Rundek, Myunghee C. Paik, Ralph L. Sacco, and Mitchell S.V. Elkind
Stroke 2007 38: 1752-1758. [Abstract] [Full Text] [PDF]