Long-term effects on survival after a 1-year multifactorial vascular risk factor intervention after stroke or TIA: secondary analysis of a randomized controlled trial, a 7-year follow-up study

• Published in: Vascular health and risk management Vol. 15; pp. 11 - 18
• Main Authors: Hagberg, Guri, Fure, Brynjar, Sandset, Else Charlotte, Thommessen, Bente, Ihle-Hansen, Håkon, Øksengård, Anne Rita, Nygård, Ståle, Wyller, Torgeir B, Ihle-Hansen, Hege
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2019; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Activities of daily living; Age Factors; Aged; Aged, 80 and over; Alcohol; Anxiety; Blood pressure; Body Mass Index; Cardiovascular disease; cardiovascular risk; Cholesterol; Clinical trials; Cognition & reasoning; Cognitive ability; Coronary heart disease; Disability Evaluation; Epidemiologi medisinsk og odontologisk statistikk: 803; Epidemiology medical and dental statistics: 803; Evidence-based medicine; Female; Follow-Up Studies; Health aspects; Health sciences: 800; Health Status; Heart; Helsefag: 800; Humans; Internal medicine; Ischemia; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - physiopathology; Ischemic Attack, Transient - therapy; Lifestyles; Male; Medical disciplines: 700; Medical prognosis; Medical records; Medisinske Fag: 700; Middle Aged; Mortality; Obesity; Original Research; Outpatient care facilities; Prevention; RCT; Recurrence; Rehabilitation; Risk Assessment; risk factor management; Risk Factors; secondary prevention; Secondary Prevention - methods; Stroke; Stroke (Disease); Stroke - diagnosis; Stroke - mortality; Stroke - physiopathology; Stroke - therapy; Time Factors; Transient ischemic attack; Treatment Outcome; VDP; Norway; RCT; secondary prevention; cardiovascular risk; stroke; risk factor management
• ISSN: 1178-2048; 1176-6344; 1178-2048
• DOI: 10.2147/VHRM.S191873

Stroke and coronary heart disease share the same risk factors, and a multifactorial intervention after stroke may potentially result in the same reduction in cardiovascular mortality as seen after coronary events. We aimed to evaluate the effect on survival 7 years after a 1-year multifactorial risk factor intervention, and identify clinical predictors for long-term survival in a hospital-based cohort of patients with first-ever stroke or transient ischemic attack (TIA). We performed a secondary analysis of a randomized controlled trial including patients between February 2007 and July 2008 comparing an intensive risk factor intervention vs usual care the first year poststroke to prevent cognitive impairment. From February 2014 to July 2016, all patients were invited to a follow-up. For patients dying throughout the follow-up period, date of death was obtained from the medical record. Examination at baseline and 1-year follow-up included extensive assessment of vascular risk factors and cognitive assessments. A total of 195 patients were randomized. Mean (SD) age was 71.6 (12.5) years, 53.3% were male, mean (SD) body mass index (BMI) was 25.6 (4.1) kg/m . During follow-up, 35 patients in the intervention group and 41 in the control group died. Kaplan-Meier survival estimates show no significant difference in intention-to-treat (ITT) population or complete case (CC) population (log-rank =0.29 vs log-rank =0.07). In multivariable Cox proportional hazards regression analyses, lower age and higher BMI was independently associated with long-term survival, adjusted HR (95% CI) 1.08 (1.05-1.11) per year and 0.91 (0.85-0.97) per kg/m . In this post hoc analysis, we found no significant effect on survival after 7 years of a multifactorial risk factor program given during the first year after first-ever stroke or TIA. Higher BMI was an independent predictor for long-term survival in this cohort.