Heart failure and the risk of stroke: the Rotterdam Study

V P Alberts, M J Bos, P J Koudstaal, A Hofman, J C M Witteman, B H C Stricker, M M B Breteler, V P Alberts, M J Bos, P J Koudstaal, A Hofman, J C M Witteman, B H C Stricker, M M B Breteler

Abstract

Patients with heart failure used to have an increased risk of stroke, but this may have changed with current treatment regimens. We assessed the association between heart failure and the risk of stroke in a population-based cohort that was followed since 1990. The study uses the cohort of the Rotterdam Study and is based on 7,546 participants who at baseline (1990–1993) were aged 55 years or over and free from stroke. The associations between heart failure and risk of stroke were assessed using time-dependent Cox proportional hazards models, adjusted for cardiovascular risk factors (smoking, diabetes mellitus, BMI, ankle brachial index, blood pressure, atrial fibrillation, myocardial infarction and relevant medication). At baseline, 233 participants had heart failure. During an average follow-up time of 9.7 years, 1,014 persons developed heart failure, and 827 strokes (470 ischemic, 75 hemorrhagic, 282 unclassified) occurred. The risk of ischemic stroke was more than five-fold increased in the first month after diagnosis of heart failure (age and sex adjusted HR 5.79, 95% CI 2.15–15.62), but attenuated over time (age and sex adjusted HR 3.50 [95% CI 1.96–6.25] after 1–6 months and 0.83 [95% CI 0.53–1.29] after 0.5–6 years). Additional adjustment for cardiovascular risk factors only marginally attenuated these risks. In conclusion, the risk of ischemic stroke is strongly increased shortly after the diagnosis of heart failure but returns to normal within 6 months after onset of heart failure.

References

    1. Bleumink GS, Knetsch AM, Sturkenboom MC, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure the Rotterdam Study. Eur Heart J. 2004;25:1614–1619. doi: 10.1016/j.ehj.2004.06.038.
    1. Bonneux LG, Huisman CC, de Beer JA. Mortality in 272 European regions, 2002–2004. An update. Eur J Epidemiol. 25:77–85.
    1. Thelle DS. The dynamics of cardiovascular epidemiology. Eur J Epidemiol. 2009;24:725–726. doi: 10.1007/s10654-009-9407-y.
    1. Stolk RP, Hutter I, Wittek RP. Population ageing research: a family of disciplines. Eur J Epidemiol. 2009;24:715–718. doi: 10.1007/s10654-009-9398-8.
    1. Chimonas T, Fanouraki I, Liberopoulos EN, Chimonas E, Elisaf M. Diverging trends in cardiovascular morbidity and mortality in a low risk population. Eur J Epidemiol. 2009;24:415–423. doi: 10.1007/s10654-009-9362-7.
    1. Tasevska-Dinevska G, Kennedy LM, Nilsson PM, Willenheimer R. Gender aspects on heart failure incidence and mortality in a middle-aged, urban, community-based population sample: the Malmo preventive project. Eur J Epidemiol. 2009;24:249–257. doi: 10.1007/s10654-009-9320-4.
    1. Szummer KE, Solomon SD, Velazquez EJ, et al. Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry. Eur Heart J. 2005;26:2114–2119. doi: 10.1093/eurheartj/ehi352.
    1. Wolf PA, Kannel WB, McNamara PM. Occult impaired cardiac function, congestive heart failure, and risk of thrombotic stroke: the Framingham Study. Neurology. 1970;20:373.
    1. Witt BJ, Gami AS, Ballman KV, et al. The incidence of ischemic stroke in chronic heart failure: a meta-analysis. J Card Fail. 2007;13:489–496. doi: 10.1016/j.cardfail.2007.01.009.
    1. Mahaffey KW, Harrington RA, Simoons ML, et al. Stroke in patients with acute coronary syndromes: incidence and outcomes in the platelet glycoprotein IIb/IIIa in unstable angina. Receptor suppression using integrilin therapy (PURSUIT) trial. The PURSUIT Investigators. Circulation. 1999;99:2371–2377.
    1. Katz SD, Marantz PR, Biasucci L, et al. Low incidence of stroke in ambulatory patients with heart failure: a prospective study. Am Heart J. 1993;126:141–146. doi: 10.1016/S0002-8703(07)80021-4.
    1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–988.
    1. Gulsvik AK, Thelle DS, Mowe M, Wyller TB. Increased mortality in the slim elderly: a 42 years follow-up study in a general population. Eur J Epidemiol. 2009;24:683–690. doi: 10.1007/s10654-009-9390-3.
    1. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur Heart J. 2008;29:2388–2442. doi: 10.1093/eurheartj/ehn309.
    1. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347:1397–1402. doi: 10.1056/NEJMoa020265.
    1. Witt BJ, Brown RD, Jr, Jacobsen SJ, et al. Ischemic stroke after heart failure: a community-based study. Am Heart J. 2006;152:102–109. doi: 10.1016/j.ahj.2005.10.018.
    1. Hofman A, Breteler MM, van Duijn CM, et al. The Rotterdam Study: 2010 objectives and design update. Eur J Epidemiol. 2009;24:553–572. doi: 10.1007/s10654-009-9386-z.
    1. Remme WJ, Swedberg K. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail. 2002;4:11–22. doi: 10.1016/S1388-9842(01)00231-8.
    1. Mosterd A, Hoes AW, de Bruyne MC, et al. Prevalence of heart failure and left ventricular dysfunction in the general population; the Rotterdam Study. Eur Heart J. 1999;20:447–455. doi: 10.1053/euhj.1998.1239.
    1. Merry AH, Boer JM, Schouten LJ, et al. Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study. Eur J Epidemiol. 2009;24:237–247. doi: 10.1007/s10654-009-9335-x.
    1. Hollander M, Bots ML, Del Sol AI, et al. Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly: the Rotterdam study. Circulation. 2002;105:2872–2877. doi: 10.1161/01.CIR.0000018650.58984.75.
    1. Bots ML, Looman SJ, Koudstaal PJ, Hofman A, Hoes AW, Grobbee DE. Prevalence of stroke in the general population the Rotterdam Study. Stroke. 1996;27:1499–1501.
    1. Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE. Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance. Stroke. 1997;28:768–773.
    1. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27:949–953. doi: 10.1093/eurheartj/ehi825.
    1. Ikram MA, Hollander M, Bos MJ, et al. Unrecognized myocardial infarction and the risk of stroke: the Rotterdam Study. Neurology. 2006;67:1635–1639. doi: 10.1212/01.wnl.0000242631.75954.72.
    1. Clark TG, Altman DG, De Stavola BL. Quantification of the completeness of follow-up. Lancet. 2002;359:1309–1310. doi: 10.1016/S0140-6736(02)08272-7.
    1. Smith JG, Platonov PG, Hedblad B, Engstrom G, Melander O. Atrial fibrillation in the Malmo diet and cancer study: a study of occurrence, risk factors and diagnostic validity. Eur J Epidemiol. 25:95–102.
    1. Heidemann C, Boeing H, Pischon T, Nothlings U, Joost HG, Schulze MB. Association of a diabetes risk score with risk of myocardial infarction, stroke, specific types of cancer, and mortality: a prospective study in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort. Eur J Epidemiol. 2009;24:281–288. doi: 10.1007/s10654-009-9338-7.
    1. Spencer EA, Pirie KL, Stevens RJ, et al. Diabetes and modifiable risk factors for cardiovascular disease: the prospective million women study. Eur J Epidemiol. 2008;23:793–799. doi: 10.1007/s10654-008-9298-3.
    1. Prugger C, Wellmann J, Heidrich J, Brand-Herrmann SM, Keil U. Cardiovascular risk factors and mortality in patients with coronary heart disease. Eur J Epidemiol. 2008;23:731–737. doi: 10.1007/s10654-008-9291-x.
    1. Romon I, Jougla E, Balkau B, Fagot-Campagna A. The burden of diabetes-related mortality in France in 2002: an analysis using both underlying and multiple causes of death. Eur J Epidemiol. 2008;23:327–334. doi: 10.1007/s10654-008-9235-5.
    1. Freudenberger RS, Schumaecker MM, Homma S. What is the appropriate approach to prevention of thromboembolism in heart failure? Thromb Haemost. 103:489–95.
    1. Pullicino P, Thompson JL, Barton B, Levin B, Graham S, Freudenberger RS. Warfarin versus aspirin in patients with reduced cardiac ejection fraction (WARCEF): rationale, objectives, and design. J Card Fail. 2006;12:39–46. doi: 10.1016/j.cardfail.2005.07.007.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit