Disability increases after stroke more than after MI
Patients who had an ischemic stroke had increased disability compared with patients who had an MI, according to a study published in JAMA Neurology.
The researchers wrote that stroke may lead to a faster functional decline than MI.
Mandip S. Dhamoon, MD, DrPH, assistant professor of neurology at Icahn School of Medicine at Mount Sinai, and colleagues reviewed data from 5,888 patients (mean age, 73 years; 42% men) from the Cardiovascular Health Study who were Medicare-eligible and were not institutionalized. Those receiving hospice care, needing a wheelchair or undergoing chemotherapy or radiotherapy were excluded.
The occurrence of stroke and MI were monitored during follow-up for a mean of 13 years. A 12-point activities of daily living scale was used to assess disability annually.
During follow-up, 6.5% of patients had an ischemic stroke and 6.7% had an MI. Patients had a mean of 3.7 visits both before and after a stroke. A mean of 3.8 assessments occurred before and after an MI.
Change in disability score near the time of the event was greater in patients who had a stroke (0.88 points; 95% CI, 0.57-1.2) vs. those with an MI (0.2 points; 95% CI, 0.09-0.2; P for difference = .04).
Patients before stroke had an annual increase of the disability score of 0.06 points (95% CI, 0.002-0.12), but experienced an addition of 0.15 points in annual increase after a stroke (95% CI, 0.004-0.3; P = .04). The annual increase before MI was 0.04 points (95% CI, 0.004-0.08), which did not change significantly after MI (0.02 additional points; 95% CI, –0.07 to 0.11; P = .69).
“Stroke is caused by conditions, including vascular risk factors and inflammation, that may have an ongoing and cumulative effect on vessel land neuronal function, including small vessels in the case of lacunar stroke and carotid arteries in the case of large-artery strokes,” Dhamoon and colleagues wrote. “In addition to causing recurrent strokes, vascular risk factors cause subclinical or covert brain injury manifest as infarcts and leukoaraiosis that may reduce functional status over the long term.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.