Is incident stroke associated with increased risk of major adverse cardiovascular events?

In this issue of Neurology ®, Sposato et al.1 perform a population-based retrospective cohort study of older adults with cardiovascular disease to determine whether initial ischemic stroke is associated with incident heart disease within the first year after stroke. The study defined major adverse cardiovascular events (MACE) as a composite outcome, specifically including myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass graft surgery, incident coronary artery disease, congestive heart failure, or cardiovascular death. The primary finding from the study is that first-ever ischemic stroke is associated with incident unadjusted MACE risk (hazard ratio [HR] 4.5, 95% confidence interval [CI] 4.3–4.8), with the adjusted risk highest in the first 30 days (HR 25.0, 95% CI 4.3–4.8); this is still significant but with lower risk in the next 60 days (HR 4.8, 95% CI 4.1–5.7), with lowest risk past 90 days (HR 2.2, 95% CI 2.0–2.4). These effect estimates are quite robust, and the authors are to be commended for their careful attention to detail when handling these data.