A multifactorial analysis of risk factors for recurrence of ischemic stroke.
OBJECTIVE
Risk factors for stroke recurrence have usually been evaluated as single variables. This study is a multivariate analysis of five risk factors (hypertension, myocardial infarction, cardiac arrhythmia, diabetes mellitus, and transient ischemic attacks) for second stroke after an initial ischemic stroke.


METHODS
Six hundred twenty-one patients with an acute ischemic stroke were followed prospectively first at 4 months after onset and then at approximately 6-month intervals until death, recurrence of stroke, or the end of the study. The five risk factors were measured at each visit. A Cox multifactorial regression analysis was conducted using the risk factor status at enrollment and adjusted for age and sex.


RESULTS
Follow-up averaged 24 months (range, 1 to 48 months). Men comprised 52% of the cohort and were slightly older; 97% of the cohort was white, and 57% had multiple risk factors. Hypertension occurred in 59%, cardiac arrhythmia in 47% (of which 16% had atrial fibrillation), diabetes mellitus in 30%, myocardial infarction in 25%, and transient ischemic attacks in 18%. Only history of hypertension and atrial fibrillation by electrocardiogram were associated with increased risk of second stroke independently and significantly (P = .01 and P = .04, respectively).


CONCLUSIONS
Among the five factors analyzed, control of hypertension and atrial fibrillation appear to offer the greatest chance of reducing risk of stroke recurrence after an ischemic stroke.
Lai
S M
SM
Department of Preventive Medicine, University of Kansas School of Medicine at Wichita 67214-3199.
Alter
M
M
Friday
G
G
Sobel
E
E
D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D048909:Diabetes Complications; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors