Long-term effects on survival after a 1-year multifactorial vascular risk factor intervention after stroke or TIA: secondary analysis of a randomized controlled trial, a 7-year follow-up study

Figures & data

Figure 1 Flowchart of the study population.

Table 1 Baseline characteristics and risk factors at 12 months

Patients characteristics	Baseline		12 months		P-value
	Intervention	Control	Intervention	Control
N	98	97	85	93
Male (%)	45 (46)	59 (61)	41 (48)	55 (59)
Age, years (mean [SD])	72.6 (11.2)	70.6 (13.6)	73.6 (11.2)	71.6 (13.6)
Stroke subtype (%)
Cerebral infarction	72 (74)	77 (79)
TIA	20 (20)	10 (10)
Cerebral hemorrhage	6 (6)	10 (10)
Risk factors (%)
Hypertension*	60 (61)	54 (65)	26 (38)	43 (62)	0.04
Hyperlipidemia	56 (57)	53 (55)	9 (10)	22 (24)	0.04
Diabetes	8 (8)	13 (13)
Cigarette smoking (present)	18 (18)	24 (25)	8 (9)	18 (19)	0.10
Coronary heart disease	21 (21)	26 (27)
Atrial fibrillation	34 (35)	24 (25)
Daily alcohol use	20 (24)	17 (18)	7 (8)	13 (14)	0.36
BMI >25	60 (61)	53 (55)	58 (53)	52 (47)	0.13
BMI, kg/m^2 (mean [SD])	26.0 (3.9)	25.1 (4.4)	26.6 (3.2)	25.7 (4.5)	0.01
OCSP classification (%)
TACI	3 (3)	7 (7)
PACI	51 (52)	47 (49)
LACI	31 (32)	30 (31)
POCI	12 (13)	13 (13)
Topography (%)
Right hemisphere	36 (37)	38 (39)
Left hemisphere	46 (47)	49 (51)
Cerebellum/brainstem	16 (16)	10 (10)
Assessments (SD)
NIHSS day 1, mean	2.0 (2.2)	3.0 (4.1)
NIHSS at discharge, mean	1.0 (1.4)	1.6 (2.8)
BI at discharge, mean	19 (2.6)	18 (3.9)
mRS at discharge, mean	1.0 (1.1)	1.3 (1.2)
MMSE, mean	26.5 (3.2)	26.1 (4.0)

Notes: Coronary heart disease, previous myocardial infarction or present angina pectoris; hyperlipidemia = total cholesterol >5 mmol/L or LDL >3 mmol/L.

* Hypertension, use of blood pressure-lowering drugs at baseline, at 12 months: systolic blood pressure >140 mmHg.

Abbreviations: blood pressure, Barthel Activities of Daily Living Index; BMI, body mass index; LACI, lacunar circulation infarction; LDL, low-density lipoprotein; MMSE, Mini Mental State Examination; mRS, modified Rankin scale; NIHSS, National Institute of Health Stroke Scale; OSCP, Oxfordshire Community Stroke Project classification; PACI, partial anterior circulation infarction; POCI, posterior circulation infarction; TACI, total anterior circulation infarction; TIA, transient ischemic attack.

Figure 2 Kaplan–Meier survival curves for (A) the intention-to-treat and (B) complete case population.

Table 3 Causes of death during follow-up

Causes of death	Intervention	Control
Heart disease	4	6
Infectious disease	10	4
Cerebrovascular disease	2	9
Cancer	4	11
Other	5	4
Missing	10	7
Total	35	41

Table 2 Cox regression; death in relation to intervention, cardiovascular risk factors, stroke subtypes, and functional and cognitive assessment

Patients characteristics	Univariate HR	95% CI	Multivariate HR	95% CI
Age (years)	1.10	1.07–1.13	1.08	1.05–1.11
Sex, male	1.11	0.71–1.75
Hypertension	0.96	0.61–1.52
Coronary heart disease	0.64	0.36–1.12
Smoking, present	0,99	0.59–1.68
Hypercholesterolemia	0.45	0.29–0.71	0.68	0.41–1.13
Daily alcohol use	0.52	0.20–1.30
Arial fibrillation	0.62	0.37–0.99	1.57	0.92–2.68
Diabetes	0.88	0.43–1.76
BMI (kg/m^2)	0.87	0.82–0.93	0.91	0.85–0.97
Stroke subype, ref: infarct
TIA	0.74	0.37–1.49
Hemorrhage	0.91	0.39–2.11
OCSP, ref: PACI
LACI	0.88	0.35–2.24
POCI	0.45	0.26–1.82
TACI	0.67	0.27–2.32
Topography, ref: left
Right	0.95	0.47–1.92
Back	1.11	0.54–2.26
NIHSS day 1	1.03	0.97–1.08
NIHSS at discharge	0.99	0.91–1.10
mRS at discharge	1.04	1.04–1.48	1.23	0.98–1.53
MMSE at discharge	0.92	0.88–0.96	0.98	0.91–1.05
Intervention	0.79	0.50–1.23

Notes: Univariate and multivariate analyses, intention-to-treat group. Variables with P<0.1 in univariate analysis were included in the multivariate analysis. Hypertension = use of blood pressure-lowering drugs at baseline, at 12 months: systolic blood pressure >140 mmHg. Coronary heart disease, previous myocardial infarction or present angina pectoris; diabetes mellitus, an established diagnosis or HbA1c ≥7.0%; hypercholesterolemia, total cholesterol >5 mmol/L or LDL >3 mmol/L.

Abbreviations: BMI, body mass index; LACI, lacunar circulation infarction; LDL, low-density lipoprotein; mRS, modified Rankin scale; MMSE, Mini Mental State Examination; NIHSS, National Institute of Health Stroke Scale; OSCP, Oxfordshire Community Stroke Project classification; PACI, partial anterior circulation infarction; POCI, posterior circulation infarction; TACI, total anterior circulation infarction; TIA, transient ischemic attack.

Figure 3 Kaplan–Meier survival curves of calculated body mass index groups.