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

A C Goulart*, A C Varella, G Tunes, A P Alencar, I S Santos, C Romagnolli, T E Gooden, G N Thomas, G Y H Lip, R D Olmos, P A Lotufo, I M Bensenor

*Corresponding author for this work

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Abstract

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: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥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.

Original languageEnglish
Article numbere12895
Number of pages9
JournalBrazilian Journal of Medical and Biological Research
Volume56
DOIs
Publication statusPublished - 22 Sept 2023

Keywords

  • Humans
  • Male
  • Aged
  • Female
  • Cohort Studies
  • Time Factors
  • Stroke/drug therapy
  • Risk Factors
  • Proportional Hazards Models

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