risk of coronary disease with stroke

Patients with disease in one vascular site often have overlapping diseases on other vascular beds. The results of one study (n=1,886) showed significant overlap between three thrombotic conditions: coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral arterial disease (PAD)(Aronow, 1994).The following results were demonstrated:
 

• 25% of patients had at least two manifestations of their thrombotic disease in different locations
• In patients with CAD, stroke was present in 32% and PAD was present in 33%
• In patients with stroke, CAD was present in 53% and PAD was present in 33%
• In patients with PAD, CAD was present in 58% and stroke was present in 34%

The Reduction of Atherothrombosis for Continued Health (REACH) Registry collects data on atherosclerosis risk factors and treatment (Bhatt, 2006b; Steg, 2006). The goal of the registry is to provide long-term, comprehensive, clinical practice data on the many manifestations of atherothrombosis in a population large enough to represent the entire spectrum of those at risk.

A total of 67,888 patients aged 45 years and older from 44 countries had either (Bhatt, 2006b):

• CAD (n=40,258);
• CVD (n=18,843);
• PAD (n=8273); or
• Asymptomatic disease but three or more risk factors for atherothrombosis (n=12,389): treated diabetes mellitus; diabetic nephropathy; ankle-brachial index <0.9; asymptomatic carotid stenosis ≥70%; carotid intima media thickness of two times or more adjacent sites; systolic blood pressure ≥150 mm Hg despite therapy for at least three months; hypercholesterolemia treated with medication; current smoking of at least 15 cigarettes per day; men aged 65 years or older; or women aged 70 years or older

One-year data from REACH also demonstrate high CV and ischemic event rates across all cerebrovascular disease populations, similar to those seen in the total population with established atherosclerotic disease (Rother, 2006). Patients with previous stroke and TIA experience had the highest event rates (including hospitalization), followed by TIA-only and stroke-only subgroups (19.61% versus 14.86% versus 12.31%, respectively (P<0.001).

The prevalence of CAD has been assessed in cross-sectional studies of patients known to have concurrent coronary heart disease (CHD)(Rothwell, 2000). Nearly 50% of the patients have either clinical or imaging evidence of vascular disease in one or more other territory (Rothwell, 2000).

In conclusion, the risk of major secondary ischemic events, including CV death, is highest in individuals with previous stroke and TIA. Improved ischemic risk reduction in TIA patients, in particular, has the potential to prevent both morbid events and associated hospitalizations. Evaluation for the presence of CAD is often appropriate.

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