Risk Factors for Stroke Differ in the Very Old

Daniel M. Keller, PhD

October 20, 2010

October 20, 2010 (Seoul, South Korea) — Very elderly patients with ischemic stroke have risk factors different from those of younger patients, reported Louisa Christensen, MD, from the Department of Neurology at Copenhagen University Hospital Bispebjerg in Denmark.

Speaking here at the 7th World Stroke Congress, Dr. Christensen said stroke severity did not differ between patients 80 years or older and their younger counterparts. In addition, the very old who survive 1 year have a good prognosis, she said.

Dr. Christensen told the audience that the risk for atrial fibrillation and stroke related to it increases dramatically with age, rising from 1.5% of those aged 50 to 59 years to 23.5% of individuals aged 80 to 89 years. She said other age-specific risk factors have not been so well-defined.

This retrospective study used data collected prospectively on 757 consecutive patients discharged from their institution with a computed tomography–verified diagnosis of ischemic stroke between February 1998 and October 2001.

Dr. Christensen said, as expected, the prevalence of atrial fibrillation was higher in the older group. Their serum homocysteine levels were also higher than in the younger group. Younger patients had more diabetes mellitus and were more likely to be smokers.

Characteristics of Older vs Younger Ischemic Stroke Patients

Factor ≥80 years (N = 279) <80 years (N = 478) P Value
Women (%) 65 42 < .001
Atrial fibrillation (%) 39.1 23 < .001
Type 1 diabetes (%) 10.6 18 .009
Hypercholesterolemia (%) 36.8 47.3 .012
Hyper-homocysteinemia (%) 32.9 24 .017
History of myocardial infarction (%) 32.2 24.9 .035
Smokers (%) 14.3 44.8 < .001

Among patients who survived a stroke for at least 1 year, Dr. Christensen said the Barthel Index of mobility and ability to perform activities of daily living was lower in the older group, at a score of 75 compared with 87 for the participants younger than 80 years (P < .001). A higher score denotes a greater likelihood of being able to live independently.

Even though stroke severity was not different between the 2 groups, the older group had higher scores on the modified Rankin Scale before the stroke, at stroke onset, and 1 year later, indicating greater disability than in the group younger than 80 years.

"Before stroke onset...the median modified Rankin [score] was 0 in the patient group below 80 years, and the ones above had a median Rankin of 1," Dr. Christensen said, indicating that the older group started with more disability, even before their strokes.

"Looking at the 1-year survivors, you could say that the improvement was equally good." The older group was worse off at all time points, but compared with their Rankin score at the time of the stroke, they made equally good progress as the younger group.

Dr. Christensen concluded that knowing the different risk factors in the elderly and very elderly can be used to focus prevention strategies. "Looking at 1-year survivors, they do have a good prognosis even if above 80, so there is no need for giving up on a patient that is above 80," she said.

Hospital-Based

Session moderator Hans-Christoph Diener, MD, PhD, professor and chairman of the Department of Neurology at the University of Duisberg-Essen in Essen, Germany, said a problem with the study is "that it is heavily biased because it is hospital-based. All these questions can only be answered in population-based studies."

As an example, he said a patient who is 90 years old and heavily demented who has a stroke will probably not go to a hospital.

Dr. Christensen disclosed receiving research grant support from the Augustinus Foundation, Daiichi-Sankyo, and Medtronic and conference attendance grant support from Boehringer-Ingelheim Denmark and Medtronic. Dr. Diener disclosed receiving consulting fees and lecture fees from Boehringer Ingelheim, Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, CoAxia, D-Pharm, Fresenius, GlaxoSmithKline, Janssen Cilag, Merck Sharp and Dohme, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi and grant support from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis, Janssen-Cilag, and Sanofi-Aventis.

7th World Stroke Congress: Abstract FC60002. Presented October 15, 2010.

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