Stroke patients with cancer are at increased risk of recurrent stroke and cardiovascular mortality

Abstract

Background: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. Methods: This was a single-centre, observational study of 1105 consecutive Chinese ischaemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. Results: Among 1105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence, 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) [P < 0.01]. In a Cox regression model, cancer, age, and atrial fibrillation were the three independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval [CI], 1.54-3.80), 1.01 (1.00-1.03), and 1.35 (1.01-1.82), respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs 2.35%/year; P = 0.08). In Cox regression analysis, cancer (HR = 2.08; 95% CI, 1.08-4.02), age (HR = 1.04; 95% CI, 1.02-1.06), heart failure (HR = 3.07; 95% CI, 1.72-5.47), and significant carotid atherosclerosis (HR = 1.55; 95% CI, 1.02-2.36) were independent predictors for cardiovascular mortality. Conclusions: Cancer patients who develop ischaemic stroke are at increased risk of recurrent stroke and cardiovascular mortality.