Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

• Published in: Brazilian journal of medical and biological research Vol. 56; no. 1; pp. 1 - e12895
• Main Authors: Goulart, A.C, Varella, A.C, Tunes, G, Alencar, A.P, Santos, I.S, Romagnolli, C, Gooden, T.E, Thomas, G.N, Lip, G.Y.H, Olmos, R.D, Lotufo, P.A, Bensenor, I.M
• Format: Journal Article
• Language: English
• Published: Ribeirao Preto Associacao Brasileira de Divulgacao Cientifica (ABDC) 01.01.2023; Revista Brasileira de Pesquisas Medicas; Associação Brasileira de Divulgação Científica
• Subjects: BIOLOGY; Cerebrovascular risk factors; Complications and side effects; Diagnosis; Evaluation; Ischemia; MEDICINE, RESEARCH & EXPERIMENTAL; Mortality; Regression analysis; Risk factors; Stroke; Stroke (Disease); Stroke epidemiology; Stroke prevention; Brazil; Cerebrovascular risk factors; Stroke prevention; Stroke epidemiology
• ISSN: 0100-879X; 1414-431X; 1414-431X; 1678-4510
• DOI: 10.1590/1414-431X2023e12895

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all- cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: [greater than or equal to]6 mo to <2.5 y). Worsening disability also impacted mortality in the period from [greater than or equal to]2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow- up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up. Key words: Stroke epidemiology; Cerebrovascular risk factors; Stroke prevention