Stroke rates in adults with congenital heart disease vary based on age

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 - brain, stroke

A retrospective study of patients with adult congenital heart disease (ACHD) found their risks of ischemic and hemorrhagic strokes were significantly higher than the general population, particularly in younger age categories.

In addition, the strongest predictors of ischemic stroke were heart failure, diabetes and recent MI.

Lead researcher Jonas Lanz. MD, MSc, of the McGill Adult Unit for Congenital Heart Disease Excellence in Montreal, and colleagues published their results online in Circulation on Nov. 23.

They examined data from the Quebec Congenital Heart Disease Database, which included information on more than 84,000 patients with ACHD who lived in Quebec between Jan. 1, 1983 and March 31, 2010.

In this population-based, cohort study, the researchers included 29,638 patients with ACHD who were from 18 to 64 years old between Jan. 1, 1998 and March 31, 2010. They excluded patients who had a stroke within 10 years of meeting the inclusion criteria.

For men, the incidence rates of ischemic stroke were 16 per 100,000 in patients from 18 to 24 years old; 63 per 100,000 in patients from 25 to 34 years old; 199 per 100,000 in patients from 35 to 44 years old; 287 per 100,000 in patients from 45 to 54 years old; and 304 per 100,000 in patients from 55 to 64 years old.

Meanwhile, the incidence rates of hemorrhagic stroke among men were 10 per 100,000 in patients from 18 to 24 years old; 8 per 100,000 in patients from 25 to 34 years old; 31 per 100,000 in patients from 35 to 44 years old; 39 per 100,000 in patients from 45 to 54 years old; and 54 per 100,000 in patients from 55 to 64 years old.

For women, the incidence rates of ischemic stroke were 29 per 100,000 in patients from 18 to 24 years old; 43 per 100,000 in patients from 25 to 34 years old; 97 per 100,000 in patients from 35 to 44 years old; 196 per 100,000 in patients from 45 to 54 years old; and 292 per 100,000 in patients from 55 to 64 years old.

Meanwhile, the incidence rates of hemorrhagic stroke among men were 5 per 100,000 in patients from 18 to 24 years old; 5 per 100,000 in patients from 25 to 34 years old; 13 per 100,000 in patients from 35 to 44 years old; 29 per 100,000 in patients from 45 to 54 years old; and 34 per 100,000 in patients from 55 to 64 years old.

The mean overall risk of ischemic stroke up to age 64 was 6.8 percent for an 18 year old woman and 8.9 percent for an 18 year old man. The cumulative risks in women were 6.1 percent for ischemic stroke and 0.8 percent for hemorrhagic stroke, while the risks in men were 7.7 percent and 1.3 percent, respectively.

Compared with the general population, patients with ACHD who were younger than 55 years old had a 9 to 12 times higher rate of ischemic stroke and a 5 to 6 times higher rate of hemorrhagic stroke. Patients with ACHD who were 55 to 64 years old had a 2 to 4 times higher rate of ischemic stroke and a 2 to 4 times higher rate of hemorrhagic stroke.

The researchers cited a few limitations, including that they did not have information on potential confounders such as tobacco, alcohol and drug abuse, medication use, family history and lifestyle factors. They also could not determine if patient had left or right sided heart failure and a bioprosthetic or mechanical valve replacement.

“Further research is required to see if early detection of risk factors and advances in the management of ACHD may reduce this substantial stroke rate,” they wrote.