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(Stroke. 2007;38:e98.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Overestimation of Coronary Risk in Stroke Patients

Université Paris-Descartes, Service de Neurologie, EA4055, Centre Hospitalier Sainte-Anne, Paris, France

Olivier Varenne, MD, PhD

Université Paris-Descartes, Service de Cardiologie, APHP, Hôpital Cochin, Paris, France

Jean-Louis Mas, MD

Université Paris-Descartes, Service de Neurologie, EA4055, Centre Hospitalier Sainte-Anne, Paris, France

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

To the Editor:

Coronary artery disease (CAD) is usually considered a significant cause of morbidity and mortality in stroke patients, although absolute risk of CAD in stroke/transient ischemic attack patients is still not well known and highest risk patients are not well identified. Dhamoon et al provide interesting data in this field, but we have concerns about the potential for misinterpretation of their conclusions, which are mainly based on risks of composite outcomes, without excluding patients with known CAD at baseline.¹

First, including stroke in vascular deaths is questionable because it does not provide precise estimates of cardiac events risk after stroke. Yet, guidelines for assessment of cardiovascular risk, including the NCEP ATP III which the authors refer to, do not consider stroke in the cardiovascular risk.^2,3 In our recent meta-analysis of 39 cohort studies (65 996 patients), the absolute risk of myocardial infarction (MI) was 2.2% (95% CI, 1.7 to 2.7) per year and that of nonstroke vascular death was 2.1% (1.9 to 2.4) per year.⁴ Fatal strokes accounted for 39/86 (45%) of vascular deaths in Dhamoon et al’s study, which explains why the risk of vascular death (17.4% at 5 years; ie, 3.5% per year) was higher than that in our meta-analysis.

Second, looking at MI only, the authors observed 19 nonfatal MI and 17 fatal MI, corresponding to a 5-year risk of 5.4% (3.3 to 7.4). Such a risk cannot be considered a high coronary risk according to guidelines for assessment of cardiovascular risk, which consider coronary . . . [Full Text of this Article]