Stroke warning signs need more urgent attention

Patients who suffer stroke-like attacks can have mortality rates 20 per cent higher than the general population, new research finds, leading to calls for better stroke prevention strategies for those who experience a transient ischemic attack (TIA).

In one of the largest studies of its kind ever conducted, more than 20,000 adults hospitalised in New South Wales between 2000-2007 with a TIA were compared against the general population for mortality rates.

A TIA occurs when blood flow to the brain ceases for a period of time, leaving a person with stroke-like symptoms for a short period. But a TIA is seen as a warning sign that a real stroke may occur in the future if preventative steps are not taken.

The study’s lead author, Dr Melina Gattellari from UNSW’s School of Public Health and Community Medicine, said nine years after a TIA, mortality rates are 20 per cent higher than for those who do not experience an attack. Not only that, after 9 years, 50 per cent of patients with a TIA had died.

TIA has long been recognised as a risk factor for early stroke. UNSW Conjoint Associate Professor John Worthington, who was also involved in the research, said the study results emphasised the long-term effects of a TIA event on mortality.

“It is time to re-examine the intensity of secondary prevention that we provide, even in people with a distant history of TIA. The brief stroke-like symptoms of transient ischemic attack are a warning of poor outcomes and an opportunity for doctors and patients to intervene before a more deadly event,” he said. “People who had a TIA five years ago remain at risk and need close medical follow-up and attention to lifestyle factors.”

Dr Gattellari said, given the research findings, there needed to be more emphasis placed on managing cardiovascular risk factors among those who experience a TIA.

“These include good blood pressure control, optimising management of diabetes and heart failure, giving up smoking, regular exercise, weight control and good management of other risk factors like atrial fibrillation,” she said.

For those over 65, a TIA can significantly reduce life expectancy. Researchers say this shows elderly patients with TIA could benefit the most from intensive cardiovascular risk management.

The research is published online in the American Heart Association journal Stroke. The researchers involved also include Chris Goumas, Frances Garden and John Worthington, and are drawn from UNSW’s School of Public Health and Community Medicine, the UNSW-affiliated Ingham Institute, and UNSW’s South Western Sydney Clinical School.