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From the Department of Epidemiology and Population Health (Dr. Kaplan), Albert Einstein College of Medicine, Bronx, NY; Departments of Neurology (Drs. Tirschwell and Longstreth), Epidemiology (Drs. Longstreth, Heckbert, and Psaty), Medicine (Dr. Psaty), and Health Services (Dr. Psaty), University of Washington, Seattle; Epidemiology and Biometry Program (Dr. Manolio), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Neurology (Dr. Lefkowitz), Wake Forest University School of Medicine, Winston-Salem, NC; and Department of Epidemiology (Dr. El-Saed), University of Pittsburgh.
Address correspondence and reprint requests to Dr. Robert C. Kaplan, Department of Epidemiology and Population Health, Belfer Building, Room 1303A, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461; e-mail: rkaplan{at}aecom.yu.edu
Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged 
65 years.
Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up.
Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications.
Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 27 issue to find the title link for this article.
Supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01 HC-15103 from the National Heart, Lung, and Blood Institute and grant 5R01AG009556-08 from the National Institute on Aging.
Disclosure: The authors report no conflicts of interest.
Received January 26, 2005. Accepted in final form June 6, 2005.
Related Article
Neurology 2005 65: 786-787.
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