Presenter of 2 Presentations
Feasibility and challenges of acute stroke care implementation in two African countries: a pilot study
RISK OF CORONARY HEART DISEASE FOLLOWING TRANSIENT ISCHEMIC ATTACKS IN THE COMMUNITY-THE FRAMINGHAM STUDY
Abstract
Background and Aims
The association between Transient ischemic attack (TIA) and stroke is well-established; the risk of non-cerebral cardiovascular events is less well described. We report the risk ,timing and time-trends for coronary heart disease (CHD) post-TIA in the community-based Framingham Study (FHS) cohort.
Methods
Longitudinal follow-up (1948-2017) of all FHS participants with TIA, free of CHD at age 35-94. Each TIA case was randomly assigned 3 age- and gender- matched CHD-free controls. Cox models were used to examine the risk of subsequent CHD, defined as coronary death or myocardial infarction. Risk was assessed in 3 epochs: 1954-1985, 1986-1999, 2000-2017.
Results
286 participants (170 women, 73.1±10.8 years) with a first-ever TIA were identified; over 9.5±8.1 [VL1] [HJJ2] years of follow-up 68 (23.8%) had CHD. The majority (85%) occurred beyond 12 months from TIA. Compared to controls, persons with TIA had a 54% higher 10-year risk of CHD, adjusting for age, sex, education level hypertension, diabetes, atrial fibrillation, and current smoking (Hazard Ratio 1.54, 95% CI 1.05-2.27, p<0.03). The risk of post-TIA CHD decreased significantly over time, from 37% between 1954-1986 to 12% in the epoch of 2000-2017; CHD risk in controls in the last epoch was 6%.
Conclusions
Compared to the general population, TIA patients are at significantly higher risk of subsequent CHD. Our findings suggest that TIA should not be viewed as a strictly cerebrovascular problem, but as herald of subsequent overall cardiovascular risk beyond stroke and highlight the need for both early intervention but also continued surveillance in this high-risk patient population.