Young women who survive MI, ischemic stroke at increased risk for another cardiovascular event, death

Women who survived an MI or ischemic stroke early in their lives had higher mortality rates and fatal and nonfatal cardiovascular events later in their lives compared with a control group, according to a long-term follow-up study.

Lead researcher Alberto Maino, MD, of the Leiden University Medical Center in the Netherlands, and colleagues published their results online in JAMA Internal Medicine on Nov. 23.

“Our findings provide direct insight into the consequences of cardiovascular diseases in young women, which persist for decades after the initial event, stressing the importance of life-long prevention strategies,” they wrote.

The researchers analyzed data from the RATIO (Risk of Arterial Thrombosis in Relation to Oral Contraceptives) study, which enrolled women between 18 and 50 years old who survived their first MI or ischemic stroke from Jan. 1, 1995 through Dec. 31, 1998. The control group included women with no history of arterial thrombosis.  

All women were followed until Dec. 31, 2012, and the researchers evaluated the data from Dec. 1, 2013, through Sept. 30, 2014.

The analysis included 226 women who survived an MI (mean age of 42.4), 160 women who survived an ischemic stroke (mean age of 40) and 782 women in the control group (mean age of 48.4).

After a median follow-up period of 18.7 years, the mortality rates were 3.7 times higher in the MI group and 1.8 times higher in the ischemic stroke group compared with the control group.

The vascular mortality rate was 3.5 per 1,000 person-years in the MI group, 2.1 per 1,000 person-years in the ischemic stroke group and 0.3 per 1,000 person-years in the control group.

The incident rates for fatal and nonfatal cardiovascular events were 14.1 per 1,000 person-years in the ischemic stroke group, 12.1 per 1,000 person-years in the MI group and 0.9 per 1,000 person-years in the control group.

For patients who survived an MI, the rate of cardiac events was 10.1 per 1,000 person-years and the rate of cerebral events was 1.9 per 1,000 person-years. For patients who survived an ischemic stroke, the rate of cardiac events was 2.7 per 1,000 person-years and the rate of cerebral events was 11.1 per 1,000 person-years.

“A limitation of this study is the possibility of survival bias owing to the case-control nature of the study cohort, and therefore absolute risks for the period shortly after the first event may have been underestimated,” the researchers wrote. “Moreover, procedures and risk factors change over time, which reduces the generalizability of our results, a problem of all long-term follow-up studies.”