Long-Term Risk and Predictors of Recurrent Stroke Beyond the Acute Phase

Abstract

Background and Purpose— Previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. This study set out to investigate the long-term risk and predictors of recurrent stroke in Northern Sweden 1995 to 2008. Methods— In the population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence registry, stroke survivors of either ischemic stroke or intracerebral hemorrhage were followed for recurrent stroke or death. Cox regression was used to identify predictors of stroke recurrence. Results— The study comprised 6700 patients and 26 597 person-years. During follow-up, 928 (13.9%) patients had a recurrent stroke. Comparison between the first time period (1995–1998) and the last (2004–2008) showed declined risk of stroke recurrence (hazard ratio, 0.64 [95% confidence interval, 0.52–0.78]). Previous myocardial infarction was less prevalent in the most recent cohort ( P <0.001). Predictors of stroke recurrence were age (hazard ratio, 1.03 [95% confidence interval, 1.02–1.04]) and diabetes mellitus (hazard ratio, 1.34 [95% confidence interval, 1.15–1.57]). After an index intracerebral hemorrhage (n=815), a major part of recurrent events were ischemic (63%), and compared with the ischemic stroke group (n=5885), a tendency toward lower risk of recurrence was observed. Conclusions— Despite declining recurrence rates in this relatively young stroke population, almost one third are either dead or have experienced a second stroke in 5 years.