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Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50 000 participants
  1. Trishna Gunnoo1,
  2. Nazeeha Hasan1,
  3. Muhammad Saleem Khan1,
  4. Julia Slark2,
  5. Paul Bentley1,
  6. Pankaj Sharma3,4
  1. 1Department of Medicine, Imperial College London, London, UK
  2. 2Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
  3. 3Ashford & St Peters Hospital, Surrey, UK
  4. 4Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL), London, UK
  1. Correspondence to Professor Pankaj Sharma; pankaj.sharma{at}


Objective Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history.

Setting A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS.

Results 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥50% coronary stenosis in 32% (95% CI 19% to 47%; p<0.00001). 8 studies with 47229 patients with ischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; p<0.00001) despite the absence of any cardiac history.

Conclusions One-third of patients with ischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history.

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