TIA, Minor Stroke Linked to Recurrent Stroke Out to 5 Years

May 22, 2018

GOTHENBURG, Sweden — Patients who have experienced a transient ischemic attack (TIA) or minor stroke still have a rising risk for recurrent stroke out to 5 years after the initial event, new data show.

Latest results from a TIA registry including almost 5000 patients show that the 5-year risk for a major vascular event was 12.9%, and half of these events occurred between 1 and 4 years after the initial TIA or minor stroke.

Dr Pierre Amarenco

"These patients were well treated in terms of guideline-recommended secondary prevention but still their risk of having a stroke in the next few years is unacceptably high," said Pierre Amarenco, MD, Université Paris-Diderot, Sorbonne-Paris Cité, France.  

"The risk does not plateau after 1 year but continues to rise right out to 5 years, so we need to do more for these patients to lower this risk, and there are now several trials underway investigating new secondary prevention approaches in this population," he said.

Amarenco presented the results at the 4th European Stroke Organisation Conference (ESOC) 2018. The results of the TIA registry were also published online in the New England Journal of Medicine to coincide with their presentation.

Commenting on the data, Martin Dichgans, MD, University of Munich, Germany, said, "This is a very impressive registry and shows us that these patients are at a higher long-term risk of major events than we might have thought. There is still a lot of room for improvement and it's good to see that new trials are targeting this population."     

Amarenco explained that the TIAregistry.org project was designed to prospectively enroll patients with a recent TIA or minor stroke in order to determine the short-term and long-term outcomes. Patients were recruited from 61 centers in 21 countries from 2009 through 2011, which Amarenco said was "in the era when emergency services for TIA and minor stroke had been implemented in the healthcare systems of many developed countries."

One-year results showing a rate of major vascular events (stroke, acute coronary syndrome, or death from cardiovascular causes) of 6.2%, most of which were strokes (5.1%), have been reported previously.

The current results show a 5-year rate of stroke, acute coronary syndrome, or death from cardiovascular causes of 12.9%, with a stroke rate of 9.5%. 

The registry was composed primarily of patients at moderate-to-high risk for stroke, as more than two thirds of the cohort had a score of 4 or more on the ABCD scale (which takes into account age, blood pressure, clinical findings, duration of symptoms, and presence or absence of diabetes).

Among stroke subtypes leading to enrollment in the registry, ipsilateral atherosclerotic stenosis, a cardiac source of embolism (mainly atrial fibrillation), and small-vessel disease were predictors of recurrent stroke during years 2 through 5.

Amarenco reported that rates of secondary prevention medication use at 5 years were good, with 70% of patients taking antihypertensives, 64% lipid-lowering therapy, 18% glucose lowering drugs, 71% antiplatelet drugs, and 17% anticoagulants.

At 5 years, the mean blood pressure was 132/77 mm Hg, the mean low-density lipoprotein (LDL) cholesterol level was 92 mg/dL, and 7.7% of patients were still active smokers.

"While these numbers are quite good there is still potential for improvement in lowering LDL levels and smoking rates further," he concluded.

The TIA registry was supported by unrestricted grants from AstraZeneca, Sanofi, and Bristol-Myers Squibb.

4th European Stroke Organisation Conference (ESOC) 2018. Presented May 16, 2018. 

N Engl J Med. Published online May 16, 2018.  Abstract  

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