Angina severity predicts ischemic stroke risk

NEW YORK (Reuters Health) – In patients with stable coronary heart disease (CHD), the severity of angina pectoris is directly related to the ischemic stroke risk, according to a report published in the January issue of Stroke: Journal of the American Heart Association.

Dr. David Tanne and colleagues, from the Chaim Sheba Medical Center in Tel-Hashomer, Israel, assessed the outcomes of 3122 patients with stable CHD who participated in a lipid modification trial. Angina severity was stratified using the Canadian Cardiovascular Society classification system, while the New York Heart Association classification system was used to stratify functional class. The mean follow-up period was 8.2 years.

During the study, 186 patients experienced an ischemic stroke, the authors note. The cumulative stroke rate was directly related to the angina class and ranged from 4.7% for patients without angina to 12.9% for angina class 3 patients (p < 0.001). In addition, as functional class worsened the risk of stroke increased (p = 0.05).

Multivariate analysis revealed that patients with class 1, 2, and 3 angina were 20%, 66%, and 135% more likely, respectively, to experience a stroke than patients without angina. Other previously identified risk factors such as diabetes and smoking were verified as important predictors of stroke.

While the development of coronary and carotid artery atherosclerosis is known to be closely related, "there are few data…on the relationship between severity of angina…and the risk of ischemic stroke during long-term followup in a large cohort of patients," the authors note.

The current findings suggest that screening for cerebrovascular disease should be considered in patients with a high angina class, the investigators state. These patients may benefit from aggressive preventive measures directed at both the coronary and the carotid process.

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