There is absolutely no way I'm going to die early because some stupid statistician ran some calculations. I've got way too much living to do .
Video discussing it at the link. My stroke was at 50 years 3 months, I'm now 57.
http://www.medpagetoday.com/Cardiology/Strokes/37967
A stroke or transient ischemic attack by age 50 at least triples
mortality risk over the subsequent decades, a Dutch study showed.
Adults
who initially survived such an event faced mortality rates of up to 3%
at 1 year, 12% at 10 years, and 27% at 20 years, Frank-Erik de Leeuw,
MD, PhD, of the Radboud University Nijmegen Medical Centre in Nijmegen,
the Netherlands, and colleagues found.
The risk was 2.6- to
3.9-fold higher than in the matched general population without stroke,
the researchers reported in the March 20 issue of the Journal of the American Medical Association.
Vascular
causes accounted for half of the deaths in the decades after a midlife
stroke, suggesting that the underlying vascular disease that caused the
stroke presented a lifelong risk, the group pointed out.
Thus,
"secondary prevention after stroke in young adults is a long-term, and
probably lifelong endeavor," Graeme Hankey, MD, of Australia's Royal
Perth Hospital, concluded in an accompanying editorial.
For
clinicians, that means recognizing the substantially-elevated risk and
then acting to treat factors like atherosclerosis, atrial fibrillation,
valvular heart disease, and smoking.
"If elimination of the cause
is not possible, long-term follow-up and control of the disease and its
risk factors need to be maintained vigilantly," Hankey wrote.
While
the results weren't surprising, they also add to the impetus to tackle
risk factors in young adults to keep stroke from happening in the first
place, Irene Katzan, MD, a neurologist at the Cleveland Clinic,
commented in an interview with MedPage Today.
The incidence of stroke before age 55 is on the rise,
now accounting for nearly 20% of strokes overall in the U.S.
population, according to a recently reported analysis that likewise
speculated on a shift in risk factors as the cause.
"Young" stroke
has been considered to have a relatively benign prognosis because of
the much lower mortality than in older adults after stroke, de Leeuw's
group noted.
Because of that longer life expectancy, the group
looked at long-term outcomes in the prospective Follow-Up of Transient
Ischemic Attack and Stroke Patients and Unelucidated Risk Factor
Evaluation (FUTURE) study.
It included 959 consecutive patients,
ages 18 through 50, admitted to a single academic medical center for a
first-ever transient ischemic attack (TIA, 262), ischemic stroke (606),
or intracerebral hemorrhage (91) from 1980 through late 2010.
In
the first 30 days after the event, the fatality rate was 0.4% for TIA,
3.6% for ischemic stroke, and 22% for hemorrhagic stroke, or 4.5%
overall.
At 1 year, the cumulative mortality rate for 30-day
survivors was 1.2% for TIA, 2.4% for ischemic stroke, and 2.9% for
intracerebral hemorrhage.
The annual mortality risk after TIA
didn't go up much, if any, over time, but the cumulative mortality of
even these "mini-strokes" was substantial at 9.2% after 10 years and
24.9% after 20 years.
After ischemic stroke, the annual mortality
risk remained fairly constant over the years, with a cumulative risk of
12.4% after 10 years and 26.8% after 20 years.
The smaller number
of hemorrhagic stroke patients who survived to 30 days resulted in a
more variable annual mortality risk ranging from less than 1% to nearly
3%.
But their long-term cumulative risk was lower than in the first 30 days, at 10.3% after 10 years and 13.7% after 20 years.
The
mortality risk over the entire follow-up period compared with an age-,
sex-, and year-matched cohort from the no-stroke general population in
the Netherlands was consistently elevated after ischemic stroke (26.8%
versus 7.6%), though only significantly higher after 10 years post TIA
(24.9% versus 8.5%).
Confidence intervals for long-term mortality
after intracerebral hemorrhage overlapped with expected rate for the
general population.
Introduction of thrombolytic therapy toward the end of the study period didn't appear to impact later mortality risks.
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