Factors associated with development of stroke long‐term after myocardial infarction: experiences from the LoWASA trial

• Published in: Journal of internal medicine Vol. 257; no. 2; pp. 201 - 207
• Main Authors: HERLITZ, J., HOLM, J., PETERSON, M., KARLSON, B. W., EVANDER, M. HAGLID, ERHARDT, L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2005; Blackwell Science
• Subjects: acute myocardial infarction; Age Factors; Aged; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Biological and medical sciences; Cerebrovascular Accident/etiology/prevention & control; Clinical Medicine; Female; Follow-Up Studies; General aspects; Humans; Hypertension - complications; Klinisk medicin; Male; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction/complications/drug therapy; Neurology; Non-Steroidal/therapeutic use; Proportional Hazards Models; Regression Analysis; Risk Factors; Smoking - adverse effects; stroke; Stroke - etiology; Stroke - prevention & control; Time Factors; Vascular diseases and vascular malformations of the nervous system; Warfarin - therapeutic use; Myocardial infarction; Nervous system diseases; Stroke; Cardiovascular disease; Myocardial disease; Long term; Cerebral disorder; Vascular disease; Medicine; Association; Heart disease; Central nervous system disease; Development; Clinical trial; Cerebrovascular disease
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/j.1365-2796.2004.01433.x

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Objective.  To describe factors associated with the development of stroke during long‐term follow‐up after acute myocardial infarction (AMI) in the LoWASA trial.
Patients.  Patients who had been hospitalized for AMI were randomized within 42 days to receive either warfarin 1.25 mg plus aspirin 75 mg daily or aspirin 75 mg alone.
Design.  The study was performed according to the probe design, that is open treatment and blinded end‐point evaluation.
Setting.  The study was performed in 31 hospitals in Sweden. The mean follow‐up time was 5.0 years with a range of 1.7–6.7 years.
Results.  In all, 3300 patients were randomized in the trial, of which 194 (5.9%) developed stroke (4.2% nonhaemorrhagic, 0.5% haemorrhagic and 1.3% uncertain. The following factors appeared as independent predictors for an increased risk of stroke: age, hazard ratio and 95% confidence interval (1.07; 1.05–1.08), a history of diabetes mellitus (2.4; 1.8–3.4), a history of stroke (2.3; 1.5–3.5), a history of hypertension (2.0; 1.5–2.7) and a history of smoking (1.5;1.1–2.0). Most of these factors were also predictors of a nonhaemorrhagic stroke whereas no predictor of haemorrhagic stroke was found.
Conclusion.  Risk indicators for stroke long‐term after AMI were increasing age, a history of either diabetes mellitus, stroke, hypertension or smoking.