Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
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Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure. / Ozga, Ann-Kathrin; Rauch, Bernhard; Palm, Frederick; Urbanek, Christian; Grau, Armin; Becher, Heiko; Rauch, Geraldine.
In: BMC PUBLIC HEALTH, Vol. 20, No. 1, 01.06.2020, p. 817.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
AU - Ozga, Ann-Kathrin
AU - Rauch, Bernhard
AU - Palm, Frederick
AU - Urbanek, Christian
AU - Grau, Armin
AU - Becher, Heiko
AU - Rauch, Geraldine
PY - 2020/6/1
Y1 - 2020/6/1
N2 - BACKGROUND: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events 1 year after the first stroke by using the new weighted all-cause hazard ratio.METHODS: This study evaluates the 1 year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced "weighted all-cause hazard ratio" was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.RESULTS: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2-0.9), 0.8 (0.4-2.2), 1.3 (0.5-2.5), 1.2 (0.3-2.7), 1.6 (0.8-3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.CONCLUSIONS: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
AB - BACKGROUND: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events 1 year after the first stroke by using the new weighted all-cause hazard ratio.METHODS: This study evaluates the 1 year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced "weighted all-cause hazard ratio" was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.RESULTS: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2-0.9), 0.8 (0.4-2.2), 1.3 (0.5-2.5), 1.2 (0.3-2.7), 1.6 (0.8-3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.CONCLUSIONS: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
U2 - 10.1186/s12889-020-08971-4
DO - 10.1186/s12889-020-08971-4
M3 - SCORING: Journal article
C2 - 32487072
VL - 20
SP - 817
JO - BMC PUBLIC HEALTH
JF - BMC PUBLIC HEALTH
SN - 1471-2458
IS - 1
ER -