Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification

Mateusz Lucki, Ewa Chlebuś, Agnieszka Wareńczak, Przemysław Lisiński, Mateusz Lucki, Ewa Chlebuś, Agnieszka Wareńczak, Przemysław Lisiński

Abstract

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50-69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.

Trial registration: ClinicalTrials.gov NCT04590287.

Keywords: CVD; ICF; secondary prevention; stroke.

Conflict of interest statement

The author(s) declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Study design. CVD—cardiovascular disease; ICF—International Classification of Functioning, Disability and Health.
Figure 2
Figure 2
Distribution of the total of CVD risk factors. CVD—cardiovascular disease; ICF—International Classification of Functioning, Disability and Health; IS—ischemic stroke.

References

    1. Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., Das S.R., de Ferranti S., Després J.P., Fullerton H.J., et al. American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report from the American Heart Association. Circultion. 2016;133:e38–360.
    1. Yamamoto H., Bogousslavsky J. Mechanisms of second and further strokes. J. Neurol. Neurosurg. Psychiatry. 1998;64:771–776. doi: 10.1136/jnnp.64.6.771.
    1. Vickrey B.G., Rector T.S., Wickstrom S.L., Guzy P.M., Sloss E.M., Gorelick P.B., Garber S., McCaffrey D.F., Dake M.D., Levin R.A. Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease. Stroke. 2002;33:901–906. doi: 10.1161/hs0402.105246.
    1. Roth G.A., Forouzanfar M.H., Forouzanfar M.H., Moran A.E., Barber R., Nguyen G., Feigin V.L., Naghavi M., Mensah G.A., Murray C.J.L., et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N. Engl. J. Med. 2015;372:1333–1341. doi: 10.1056/NEJMoa1406656.
    1. Mendis S., Abegunde D., Yusuf S., Ebrahim S., Shaper G., Ghannem H., Shengelia B. WHO study on Prevention of Recurrences of Myocardial Infarction and StrokE (WHO-PREMISE) Bull. World Health Organ. 2005;83:820–829.
    1. Yuan H.W., Wang C.X., Zhang N., Bai Y., Shi Y.Z., Zhou Y., Wang Y.L., Zhang T., Zhou J., Yu X., et al. Poststroke depression and risk of recurrent stroke at 1 year in a Chinese cohort study. PLoS ONE. 2012;7:e46906. doi: 10.1371/journal.pone.0046906.
    1. Cappuccio F.P., Cooper D., D’Elia L., Strazzullo P., Miller M.A. Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. Eur. Heart J. 2011;32:1484–1492. doi: 10.1093/eurheartj/ehr007.
    1. Woodward M., Webster R., Murakami Y., Barzi F., Lam T.H., Fang X., Suh I., Batty G.D., Huxley R., Rodgers A., et al. The association between resting heart rate, cardiovascular disease and mortality: Evidence from 112 680 men and women in 12 cohorts. Eur. J. Prev. Cardiol. 2014;21:719–726. doi: 10.1177/2047487312452501.
    1. Lip G.Y., Hunter T.D., Quiroz M.E., Ziegler P.D., Turakhia M.P. Atrial Fibrillation Diagnosis Timing, Ambulatory ECG Monitoring Utilization and Risk of Recurrent Stroke. Circ. Cardiovasc. Qual. Outcomes. 2017;10:e002864. doi: 10.1161/CIRCOUTCOMES.116.002864.
    1. Orrapin S., Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst. Rev. 2017;6:CD001081. doi: 10.1002/14651858.CD001081.pub3.
    1. Liu L., Wang Z., Gong L., Zhang Y., Thijs L., Staessen J.A., Wang J. Blood pressure reduction for the secondary prevention of stroke: A Chinese trial and a systematic review of the literature. Hypertens. Res. 2009;32:1032–1040. doi: 10.1038/hr.2009.139.
    1. Weiner D.E., Tighiouart H., Stark P.C., Amin M.G., MacLeod B., Griffith J.L., Salem D.N., Levey A.S., Sarnak M.J. Kidney disease as a risk factor for recurrent cardiovascular disease and mortality. Am. J. Kidney Dis. 2004;44:198–206. doi: 10.1053/j.ajkd.2004.04.024.
    1. Pisters R., Lane D.A., Nieuwlaat R., de Vos C.B., Crijns H.J., Lip G.Y. A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest. 2010;138:1093–1100. doi: 10.1378/chest.10-0134.
    1. Gerner S.T., Kuramatsu J.B., Sembill J.A., Sprügel M.I., Hagen M., Knappe R.U., Endres M., Haeusler K.G., Sobesky J., Schurig J., et al. Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage. Stroke. 2019;50:1392–1402. doi: 10.1161/STROKEAHA.118.023492.
    1. Wu S., Shi Y., Wang C., Jia Q., Zhang N., Zhao X., Liu G., Wang Y., Liu L., Wang Y., et al. Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in A Chinese cohort study. PLoS ONE. 2013;8:e80690. doi: 10.1371/journal.pone.0080690.
    1. Amarenco P., Bogousslavsky J., Callahan A., Goldstein L.B., Hennerici M., Rudolph A.E., Sillesen H., Simunovic L., Szarek M., Welch K.M., et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N. Engl. J. Med. 2006;355:549–559.
    1. Ois A., Gomis M., Rodríguez-Campello A., Cuadrado-Godia E., Jiménez-Conde J., Pont-Sunyer C., Cuccurella G., Roquer J. Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke. Stroke. 2008;39:1717–1721. doi: 10.1161/STROKEAHA.107.505438.
    1. Narum S., Solhaug V., Myhr K., Brørs O., Kringen M.K. Characterisation of non-warfarin-associated bleeding events reported to the Norwegian spontaneous reporting system. Eur. J. Clin. Pharmacol. 2013;69:1445–1452. doi: 10.1007/s00228-013-1479-7.
    1. Epstein K.A., Viscoli C.M., Spence J.D., Young L.H., Inzucchi S.E., Gorman M., Gerstenhaber B., Guarino P.D., Dixit A., Furie K.L., et al. Smoking cessation and outcome after ischemic stroke or TIA. Neurology. 2017;89:1723–1729. doi: 10.1212/WNL.0000000000004524.
    1. Strazzullo P., D’Elia L., Cairella G., Garbagnati F., Cappuccio F.P., Scalfi L. Excess body weight and incidence of stroke: Meta-analysis of prospective studies with 2 million participants. Stroke. 2010;41:e418–e426. doi: 10.1161/STROKEAHA.109.576967.
    1. Adams R.J., Chimowitz M.I., Alpert J.S., Awad I.A., Cerqueria M.D., Fayad P., Taubert K.A. American Heart Association/American Stroke Association. Stroke Council and the Council on Clinical Cardiology of the American Heart Association; American Stroke Association. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: A scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Stroke. 2003;34:2310–2322.
    1. Maritz R., Aronsky D., Prodinger B. The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records. Appl. Clin. Inform. 2017;8:964–980. doi: 10.4338/ACI-2017050078.
    1. Chen S., Tao J., Tao Q., Fang Y., Zhou X., Chen H., Chen Z., Huang J., Chen L., Chan C.C. Rater experience influences reliability and validity of the Brief International Classification of Functioning, Disability, and Health Core Set for Stroke. J. Rehabil. Med. 2016;48:265–272. doi: 10.2340/16501977-2063.
    1. Lee H., Seo S., Song J. Information on functioning found in the medical records of patients with stroke. J. Phys. Ther. Sci. 2016;28:2722–2726. doi: 10.1589/jpts.28.2722.
    1. Lucki M., Chlebuś E., Wareńczak A., Lisiński P. The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage. Medicina. 2021;57:190. doi: 10.3390/medicina57030190.
    1. Ceccarini M., Manzoni G.M., Castelnuovo G. Assessing depression in cardiac patients: What measures should be considered? Depress Res. Treat. 2014;2014:148–256. doi: 10.1155/2014/148256.
    1. Cuspidi C., Tadic M., Grassi G., Mancia G. Treatment of hypertension: The ESH/ESC guidelines recommendations. Pharmacol. Res. 2018;128:315–321. doi: 10.1016/j.phrs.2017.10.003.
    1. Inker L.A., Astor B.C., Fox C.H., Isakova T., Lash J.P., Peralta C.A., Kurella Tamura M., Feldman H.I. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am. J. Kidney Dis. 2014;63:713–735. doi: 10.1053/j.ajkd.2014.01.416.
    1. Inzucchi S.E., Bergenstal R.M., Buse J.B., Diamant M., Ferrannini E., Nauck M., Peters A.L., Tsapas A., Wender R., Matthews D.R. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–149. doi: 10.2337/dc14-2441.
    1. Schwartz G.G., Steg P.G., Szarek M., Bhatt D.L., Bittner V.A., Diaz R., Edelberg J.M., Goodman S.G., Hanotin C., Harrington R.A., et al. ODySSEy OUTCOMES Committees and Investigators. Alirocumab and car-diovascular outcomes after acute coronary syndrome. N. Engl. J. Med. 2018;379:2017–2097. doi: 10.1056/NEJMoa1801174.
    1. Wood A.M., Kaptoge S., Butterworth A.S., Willeit P., Warnakula S., Bolton T., Paige E., Paul D.S., Sweeting M., Burgess S., et al. Risk thresholds for alcohol consumption: Combined analysis of individual-participant data for 599,912 current drinkers in 83 prospective. Lancet. 2018;391:1513–1523. doi: 10.1016/S0140-6736(18)30134-X.
    1. Zhang J., Wang Y., Wang G.N., Sun H., Sun T., Shi J.Q., Xiao H., Zhang J.S. Clinical factors in patients with ischemic versus hemorrhagic stroke in East China. World J. Emerg. Med. 2011;2:18–23. doi: 10.5847/wjem.j.1920-8642.2011.01.003.
    1. McCarthy D.J., Diaz A., Sheinberg D.L., Snelling B., Luther E.M., Chen S.H., Yavagal D.R., Peterson E.C., Starke R.M. Long-Term Outcomes of Mechanical Thrombectomy for Stroke:A Meta-Analysis. Sci. World J. 2019;2:7403104.
    1. Hemphill J.C., Greenberg S.M., Anderson C.S., Becker K., Bendok B.R., Cushman M., Fung G.L., Goldstein J.N., Macdonald R.L., Mitchell P.H., et al. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2032–2060.
    1. Zhang Y., Chapman A.M., Plested M., Jackson D., Purroy F. The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US: A Literature Review. Stroke Res. Treat. 2012;2012:436125. doi: 10.1155/2012/436125.
    1. Tsai C.F., Jeng J.S., Anderson N., Sudlow C.L.M. Comparisons of Risk Factors for Intracerebral Hemorrhage versus Ischemic Stroke in Chinese Patients. Neuroepidemiology. 2017;48:72–78. doi: 10.1159/000475667.
    1. Hindy G., Engström G., Larsson S.C., Traylor M., Markus H.S., Melander O., Orho-Melander M., Stroke Genetics Network (SiGN) Role of blood lipids in the development of ischemic stroke and its subtypes: A mendelian randomization study. Stroke. 2018;49:820–827. doi: 10.1161/STROKEAHA.117.019653.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir