Patients with heart failure used to have an increased risk of stroke, but this may have changed with current treatment regimens. We assessed the association between heart failure and the risk of stroke in a population-based cohort that was followed since 1990. The study uses the cohort of the Rotterdam Study and is based on 7,546 participants who at baseline (1990–1993) were aged 55 years or over and free from stroke. The associations between heart failure and risk of stroke were assessed using time-dependent Cox proportional hazards models, adjusted for cardiovascular risk factors (smoking, diabetes mellitus, BMI, ankle brachial index, blood pressure, atrial fibrillation, myocardial infarction and relevant medication). At baseline, 233 participants had heart failure. During an average follow-up time of 9.7 years, 1,014 persons developed heart failure, and 827 strokes (470 ischemic, 75 hemorrhagic, 282 unclassified) occurred. The risk of ischemic stroke was more than five-fold increased in the first month after diagnosis of heart failure (age and sex adjusted HR 5.79, 95% CI 2.15–15.62), but attenuated over time (age and sex adjusted HR 3.50 [95% CI 1.96–6.25] after 1–6 months and 0.83 [95% CI 0.53–1.29] after 0.5–6 years). Additional adjustment for cardiovascular risk factors only marginally attenuated these risks. In conclusion, the risk of ischemic stroke is strongly increased shortly after the diagnosis of heart failure but returns to normal within 6 months after onset of heart failure.
Bonneux LG, Huisman CC, de Beer JA. Mortality in 272 European regions, 2002–2004. An update. Eur J Epidemiol. 25:77–85.
Wolf PA, Kannel WB, McNamara PM. Occult impaired cardiac function, congestive heart failure, and risk of thrombotic stroke: the Framingham Study. Neurology. 1970;20:373. PubMed
Mahaffey KW, Harrington RA, Simoons ML, et al. Stroke in patients with acute coronary syndromes: incidence and outcomes in the platelet glycoprotein IIb/IIIa in unstable angina. Receptor suppression using integrilin therapy (PURSUIT) trial. The PURSUIT Investigators. Circulation. 1999;99:2371–7. PubMed
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8. PubMed
Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29:2388–442. CrossRefPubMed
Bots ML, Looman SJ, Koudstaal PJ, Hofman A, Hoes AW, Grobbee DE. Prevalence of stroke in the general population the Rotterdam Study. Stroke. 1996;27:1499–501. PubMed
Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE. Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance. Stroke. 1997;28:768–73. PubMed
Smith JG, Platonov PG, Hedblad B, Engstrom G, Melander O. Atrial fibrillation in the Malmo diet and cancer study: a study of occurrence, risk factors and diagnostic validity. Eur J Epidemiol. 25:95–102.
Heidemann C, Boeing H, Pischon T, Nothlings U, Joost HG, Schulze MB. Association of a diabetes risk score with risk of myocardial infarction, stroke, specific types of cancer, and mortality: a prospective study in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort. Eur J Epidemiol. 2009;24:281–8. CrossRefPubMed
Freudenberger RS, Schumaecker MM, Homma S. What is the appropriate approach to prevention of thromboembolism in heart failure? Thromb Haemost. 103:489–95.
- Heart failure and the risk of stroke: the Rotterdam Study
V. P. Alberts
M. J. Bos
P. J. Koudstaal
J. C. M. Witteman
B. H. C. Stricker
M. M. B. Breteler
- Springer Netherlands