CAD confers 2 x risk of stroke, with LVH is 3x risk, chf is 4x risk. The attributable risk of CAD is 12 % and ranges from 2.3-6 % for CHF. Post MI stroke risk over five years is 8.1 percent, higher in older patients, in pts with ef< 28 % (rr 1.86).
Symptomatic carotid stenosis confers 26 % risk of recurrent stroke with medical treatment after tia/minor stroke over ? time, and asymptomatic stenosis risk is 1.3 % annually if stenosis is <75> 3.3 %. (Norris 1991). The combined tia/stroke risk is 10.5 % per year with >75 % stenosis(????). ACAS randomized 1662 patients. Angio risk was 1.2 % and perioperative risk was 2.3 %. After median followup of 2.7 years, study was stopped due to benefit ( 11 % of those with medical treatment had stroke ipsilateral, whereas surgical + medical had 5 % ipsilateral stroke, perioperative stroke or death in five years, 55% risk reduction). More benefit among men, no effect of degree of stenosis. Halliday et al, 2004, showed in another trial that in patients <75 with severe carotid stenosis, the stroke risk in the surgery deferred group was similar to that seen in ACAS. Medical group risk was 11 %, in immediate surgery group was 3.8 % at five years, Perioperative risk of stroke/death was 3.1 % effect equal in gender groups.
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