Published Online
on April 12, 2007

A more recent version of this article appeared on June 1, 2007

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Submitted on December 20, 2006
Revised on January 17, 2007
Accepted on January 19, 2007

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

Mandip S. Dhamoon MD, MPH; Wanling Tai; Bernadette Boden-Albala DrPH; Tanja Rundek MD, PhD; Myunghee C. Paik PhD; Ralph L. Sacco MD, MS; and Mitchell S.V. Elkind MD, MS, FAAN^*

From the Department of Neurology (M.S.D., B.B.-A., T.R., R.L.S., M.S.V.E.), College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Biostatistics (W.T., M.C.P.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; the Department of Sociomedical Sciences (B.B.-A.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; the Gertrude H. Sergievsky Center (R.L.S., M.S.V.E.), College of Physicians and Surgeons, Columbia University, New York, NY; and the Division of Epidemiology (R.L.S.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY.

^* To whom correspondence should be addressed. E-mail: mse13{at}columbia.edu.

Background and Purpose--In national guidelines, absolute long-term risk of myocardial infarction (MI) or coronary death determines target low-density lipoprotein levels, but stroke patients are not explicitly addressed. We determined the absolute 5-year risk of cardiovascular outcomes and their predictors after first ischemic stroke in a multiethnic cohort.

Methods--A population-based cohort of first ischemic stroke patients 40 years old was prospectively followed annually for recurrent stroke, MI and cause-specific mortality. Kaplan-Meier 5-year risks for MI or vascular death (primary outcome), and other cardiovascular events, were calculated. Univariate and multivariate Cox proportional hazards models were used to calculate hazard ratios and 95% CI for predictors of cardiovascular outcomes.

Results--Mean age (n=655) was 69.7±12.7 years; 55.4% of participants were women, and 51.3% Hispanic. The 5-year risk of MI or vascular death was 17.4% (95% CI, 14.2% to 20.6%). Independent historical predictors of MI or vascular death were age >70 years (hazard ratio 1.62, 1.07 to 2.44), history of coronary artery disease (hazard ratio 1.76, 1.13 to 2.74), and atrial fibrillation (hazard ratio 1.76, 1.05 to 2.94). In the lowest risk group, those 70 years old without coronary artery disease, 5-year risk of MI or vascular death was 9.7%.

Conclusions--The absolute risk of MI or vascular death after ischemic stroke, even in those without high-risk features, approximates levels used by national organizations to designate groups of patients at high risk of vascular events. The comparability of levels of absolute risk among stroke and cardiac patients may have treatment implications.

Key words: cerebrovascular disease • mortality • prognosis • risk factors • stroke

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