Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study.


Goulart, AC ORCID: 0000-0003-1076-5210, Varella, AC ORCID: 0000-0002-2487-8489, Tunes, G ORCID: 0000-0003-3088-3134, Alencar, AP ORCID: 0000-0002-0779-0426, Santos, IS ORCID: 0000-0003-3212-8466, Romagnolli, C ORCID: 0000-0002-4893-6794, Gooden, TE ORCID: 0000-0002-3905-5477, Thomas, GN ORCID: 0000-0002-2777-1847, Lip, GYH ORCID: 0000-0002-7566-1626, Olmos, RD ORCID: 0000-0002-7569-4735 et al (show 2 more authors) (2023) Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study. Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas, 56. e12895-.

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Abstract

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.

Item Type: Article
Uncontrolled Keywords: Humans, Proportional Hazards Models, Risk Factors, Cohort Studies, Time Factors, Aged, Female, Male, Stroke
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 14 Dec 2023 09:19
Last Modified: 14 Dec 2023 09:30
DOI: 10.1590/1414-431x2023e12895
Open Access URL: https://doi.org/10.1590/1414-431X2023e12895
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3177382
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