title: Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Estimates of risk of stroke recurrence are widely variable and focused on the short- term. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence.
  
  
  METHODS
  Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI.
  
  
  RESULTS
  Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115 survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7-4.4) at 30 days, 11.1% (95% CI, 9.0-13.3) at 1 year, 26.4% (95% CI, 20.1-32.8) at 5 years, and 39.2% (95% CI, 27.2-51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies.
  
  
  CONCLUSIONS
  The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence.
authors: King's College London, Division of Health and Social Care Research, and Department of Elderly Care, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, 7 Floor Capital House, 42 Weston St, London SE1 3QD, UK. kitty.mohan@kcl.ac.uk
authors: Keerthi M
authors: KM
authors: Mohan
authors: Charles D A
authors: CD
authors: Wolfe
authors: Anthony G
authors: AG
authors: Rudd
authors: Peter U
authors: PU
authors: Heuschmann
authors: Peter L
authors: PL
authors: Kolominsky-Rabas
authors: Andrew P
authors: AP
authors: Grieve
mesh_terms: D006801:Humans; D015233:Models, Statistical; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology*