Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register
Abstract
Background and Purpose— This article examines stroke recurrence and whether the subtype of the initial stroke influences the risk and subtypes of further strokes. The proportion of recurrences attributable to conventional risk factors is quantified. Methods— From January 1995 to August 2000, all first-in-a-lifetime strokes (n=1626) were identified and prospectively followed up in a defined multiethnic inner city population of 234 533. Twelve overlapping referral sources and face-to-face follow-up at 3 months and 1 and 3 years were used to attain complete registration of stroke recurrence. Index and recurrent stroke were classified according to the Oxford Community Stroke Project classification. Results— In 2744 person-years of follow-up, 153 recurrences were observed. At 5 years, the cumulative risk of first stroke recurrence was 16.6% (95% CI, 13.5 to 20.4), and the combined risk of death or stroke recurrence was 65.3% (95% CI, 61.9 to 68.6). Ethnicity and subtype of index stroke were not associated with stroke recurrence. A change in subtype between index and recurrent stroke occurred in 45.5% (95% CI, 35.8 to 55.2) of cases and was most frequent among index lacunar strokes and primary intracerebral hemorrhages. In multivariable analyses, diabetes mellitus and atrial fibrillation were associated with both stroke recurrence and recurrence-free survival. In the stroke population, 9.1% (95% CI, −2.0 to 20.2) of recurrences were attributable to diabetes and 4.9% (95% CI, −7.3 to 17.2) to atrial fibrillation during the first year after the index stroke. Conclusions— The cause of stroke recurrence is multifactorial, and the subtypes of index and recurrent strokes are often not identical. Most recurrences remain unexplained by conventional risk factors.
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Prognosis of CAD in diabetic patients is worse than in non-diabetic subjects.
“prognosis of CAD in diabetic patients is worse than in non-diabetic subjects137–139)”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [139]
Secondary prevention of CAD in diabetic patients shows a high rate of recurrence.
“Secondary-prevention of CAD in diabetic patients shows a high rate of recurrence137–139, 839), and it is difficult to achieve plaque regression in patients with DM even with the recommended control of LDL-C-lowering therapy840).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [139]
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- Authors
- Hillen, T., Coshall, C., Tilling, K., Rudd, A. G., McGovern, R., & Wolfe, C. D. A.
- Affiliations
- St Thomas' Hospital (GB)
- Venue
- Stroke
- Published
- 2003-06
- Volume
- 34
- Issue
- 6
- Pages
- 1457-1463
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2095596783
- Cited by
- 298
- References
- 24
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 11 · 2023: 9 · 2022: 15 · 2021: 21 · 2020: 18 · 2019: 18 · 2018: 15 · 2017: 13 · 2016: 12 · 2015: 17 · 2014: 17 · 2013: 14 · 2012: 13
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- stroke recurrence, stroke subtypes, lacunar stroke, intracerebral hemorrhage, diabetes mellitus, atrial fibrillation, stroke risk factors, recurrence-free survival, ethnic differences, multifactorial etiology
- MeSH terms
- Aged, Atrial Fibrillation, Diabetes Mellitus, Female, Follow-Up Studies, Humans, London, Male, Prospective Studies, Recurrence, Registries, Risk Factors, Comorbidity, Causality, Life Tables, Incidence, Multivariate Analysis, Survival Analysis, Treatment Outcome, Risk Assessment, Disease-Free Survival, Stroke
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