Women and men more likely to have another major cardiovascular event after stroke

New research from Western University has shown that both women and men are significantly more likely to have a heart attack or another major cardiovascular event within thirty days of having a stroke.

The study led by Dr. Luciano Sposato, Associate Professor and the Kathleen and Henry Barnett Chair in Stroke at Western's Schulich School of Medicine & Dentistry, was published in the American Heart Association Journal, Stroke.

The study demonstrated for the first time that in people with no underlying heart disease, after a stroke they were more than 20 times more likely than those who didn't have a stroke (23-fold in women and 25-fold in men) to have a first-in-life major adverse cardiovascular event. These events include things like heart attack, chest pain, cardiac failure or cardiac death.

This risk dropped after 30 days, but even one year after a stroke, men and women both still had twice the risk of a major cardiac event than those who didn't have a stroke.

The research team examined ICES data for more than 90,000 adults over the age of 65 in Ontario with no pre-existing clinical diagnosis of heart disease. The researchers examined the incidence of cardiac events in two groups - a group of just over 20,000 that had a stroke and a group of approximately 70,000 individuals without stroke but with similar vascular risk factors, comorbidities and demographic characteristics.

The researchers point out that the connection between cardiovascular events and stroke has often been believed to be the result of shared risk factors like high blood pressure, diabetes or smoking. However, in this study there was the same proportion of these risk factors in both groups - the group that had a stroke, and the group that did not.

This shows that after taking risk factors into consideration, having experienced a recent stroke was independently associated with the incidence of major adverse cardiac events. This leads us to believe that there are underlying mechanisms linked to stroke that may be causing heart disease."

Dr. Luciano Sposato, director of the Heart & Brain Laboratory at Western University

In a paper published earlier in 2019, Dr. Sposato and collaborators used animal models to back up this finding by demonstrating that the brain damage caused by stroke leads to inflammation and scarring in the left atrium of the heart. These changes are well-known structural abnormalities for a number of heart diseases such as heart attacks, heart failure and cardiac arrhythmias. "This is the first animal model that clearly demonstrates how stroke can influence scarring in the heart. We are excited to continue work in this area to target these influencing factors to prevent heart disease following stroke," said Shawn Whitehead, PhD, Associate Professor at Schulich Medicine & Dentistry who was co-principal investigator of the study in rats.

Dr. Sposato hopes this information will inform clinical practice and encourage health care providers to watch for cardiovascular symptoms in patients who recently had strokes.

"My hope is that neurologists, cardiologists and scientists can work more closely together on this brain heart connection so that in the future we can understand and target the underlying mechanisms to prevent heart disease after stroke," he said.

Source:
Journal reference:

Sposato, L. A., et al. (2020) First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men. Stroke. doi.org/10.1161/STROKEAHA.119.028066.

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