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Odds of Second Stroke Are High

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THURSDAY, June 16 (HealthDayNews) -- People who have had a minor stroke have a 43 percent risk of another, potentially fatal stroke within 10 years, Dutch researchers report.

While deaths from cerebrovascular disease have dropped around the world, stroke remains a serious neurological problem, leaving many patients with a chronic disability. After a stroke, or transient ischemic attack (TIA), secondary stroke prevention is standard practice. But many patients have a recurrent stroke or other vascular complications, according to the report in the June 18 issue of The Lancet.

"The risk for a vascular event is very high in these people," said study author Dr. Ale Algra, of the Julius Centre for Health Sciences and Primary Care at the University Medical Centre Utrecht.

In their study, Algra and his colleagues collected data on 2,447 patients who had had a minor stroke, which is a transient stroke that lasts only a few minutes. These patients had participated in the Dutch TIA Trial.

After a follow-up of 10.1 years, 60 percent of the patients had died and 54 percent had had at least one vascular event. This is twice as many deaths as would be seen in the general population, Algra said. The 10-year risk of death was 42.7 percent, Algra's team found.

The risk of a vascular event was highest shortly after the stroke, reached its lowest point about three years later, and then gradually rose again, the researchers said.

Given these findings, Algra believes more emphasis should placed on preventing second strokes. "People should pay attention to secondary prevention," he said. "This includes lifestyle, as well as drug therapy."

In terms of lifestyle, Algra suggested exercising, eating a healthy diet, and not smoking. In addition, doctors should work to keep their patients' blood pressure and cholesterol low and prescribe aspirin or other drugs to prevent blood from clotting in the small arteries. "All these measures together may decrease the risks of new vascular events," he said.

One expert agrees that secondary prevention after a minor stroke is often overlooked. "This study makes us say 'Holy moly, these early risks of recurrence are very high,'" said Dr. Lawrence M. Brass, a professor of neurology and epidemiology and public health at Yale University School of Medicine.

For the medical community, Brass thinks this study sends a strong message that secondary stroke prevention needs to be a priority.

"Often the approach of many physicians is, 'You've had a TIA. Let's put you on an aspirin and send you on your way,'" he said. "This data indicates that half these people are going to be dead in five years, and a similar portion may have another stroke. You've really got to do more than just this."

Brass noted there are many things doctors can do that are often not done to help prevent second, fatal strokes, such as monitoring blood pressure and cholesterol. "This is a real wake-up call," Brass said. "We've got to get our butts in gear to make sure we are doing things appropriately."

Patients, too, can play a role in preventing the recurrence of stroke, Brass said. "Patients should know what their risk is, and know what they and their doctors are doing about it," he said.

"People need to realize that heart attack and stroke are going to kill me, not dirt on the oranges or something else. This is what's going to kill more Americans than anything else," Brass said. "You need to be an active advocate and say to your doctor, 'What are my risks for heart attack and stroke? What are we doing to prevent it? What more can we do to prevent it?'"

More information

The American Stroke Association can tell you more about stroke.

SOURCES: Ale Algra, M.D., Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; Lawrence M. Brass, M.D., professor, neurology and epidemiology and public health, Yale University School of Medicine, New Haven, Conn.; June 18, 2005, The Lancet
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