Background Studies of coronary events after stroke in the long term are scarce. We sought to investigate the long-term risk of stroke recurrence and coronary events, and their predictors in young and middle-aged ischemic stroke patients. Methods This is a longitudinal study of 1,086 consecutive adult cases with ischemic stroke before 70 years of age, and 600 community controls without cardiovascular disease at baseline. Participants were followed through national registers and medical records. Cox regression models were developed to identify predictors of vascular events. Results One-hundred-seventy-six cases experienced recurrent stroke (median follow-up 7 years) and 84 a coronary event (median follow-up 8 years), whereas the corresponding numbers were 12 and 32 for controls (median follow-up 10 years). The event rate (ER) for stroke was 10 times greater for cases than controls, whereas the coronary event rate was twice as high (ER per 1,000 person years 23.8 (95% confidence interval (CI) 20.4-27.6) versus 1.9 (95% CI 1.0-3.3) and 10.6 (95% CI 8.4-13.1) versus 5.2 (95% CI 3.5-7.3), respectively). Independent associations were detected for living alone and recurrent stroke (adjusted hazard ratio (HR) 1.67 (95% CI 1.23 - 2.27), p=0.001) and for pre-stroke sedentary leisure time and coronary events (adjusted HR 2.14 (95% CI 1.32 - 3.46), p=0.002). In addition, age and previous cardiovascular disease were independently associated to both outcomes. Conclusion Ischemic stroke patients remain at elevated risk for recurrent vascular events for many years after stroke. We identified living alone and sedentary leisure time as novel predictors of recurrent stroke and coronary events.
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