Patients With TIA or Minor Stroke Have 1 in 5 Risk of Subsequent Stroke Over 10 Years
The long-term risk of stroke after transient ischemic attack (TIA) or minor stroke is 5.9% within 1 year, 12.8% within 5 years, and 19.8% within 10 years, according to a systematic review and meta-analysis published in JAMA.
“Patients who have had a TIA or minor stroke are at a persistently high risk of subsequent stroke,” wrote lead author Faizan Khan, PhD, of the University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada, and study coauthors. “Findings from this study underscore the need for improving long-term stroke prevention measures in this patient group.”
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The systematic review and meta-analysis included 38 studies that reported stroke risk over at least 1 year of follow-up in a total 171,068 patients with TIA or minor stroke. Participants were from 20 countries across 4 continents, and the median age was 69 years.
Per 100 person-years, the pooled rate of stroke in the first year was 5.94 events across all 38 studies, researchers reported. In the second through fifth years, the pooled rate was 1.80 events annually per 100 person-years across 25 studies. In the sixth through tenth years, the pooled rate was 1.72 events annually per 100 person-years across 12 studies.
Stroke rates were higher in studies conducted in North America (1.43 rate ratio [RR]) and Asia (1.62 RR) compared with Europe, according to the study. Rates were also higher for patient cohorts in 2007 or after (1.42 RR) and in studies with active outcome ascertainment methods compared with passive methods (1.11 RR).
In contrast, stroke rates were lower in studies that focused exclusively on patients with TIA (0.68 RR) or first-ever index events (0.45 RR) compared with an unselected patient population.
“I know that adherence to medical recommendations can wane over time. People start to feel better, and the more time that passes after the first stroke, they might reconsider whether the medication and lifestyle changes are necessary,” study principal investigator Michael Hill, MD, a professor at the University of Calgary Cumming School of Medicine said in a news release.
“I hope this study serves as a bit of a wake-up call. If you know your risk is 1 in 5 of having another stroke over 10 years, and 10% of those cases are fatal, you may be more likely to continue the medications and lifestyle changes.”
