Five-Year Risk of Cardiovascular Events after Transient Ischemic Attack: Results from a Prospective Cohort

Objectives. There are few contemporary, prospective studies reporting on the long-term risk of stroke and other cardiovascular (CV) events after transient ischemic attack (TIA). The primary aim was to examine the risk of new CV events within 5 years after TIA. The secondary aim was to identify baseline predictors of long-term CV events, including inflammatory biomarkers in a subgroup analysis. Materials and Methods. In a prospective, multicenter study, we enrolled 577 TIA patients between 2012 and 2014. The primary outcome was a composite of stroke, acute coronary syndrome, and CV death. We used data from the Norwegian Cardiovascular Disease Registry. In a subgroup of 112 patients, blood samples were analyzed for inflammatory biomarkers. Results. The primary outcome occurred in 108 patients (18.7%), of which 69 patients (12.0%) had a stroke. Sixty-one (56.5%) of the events occurred during year two through five. Increasing age (HR 1.05; 95% CI, 1.03-1.08), male sex (HR 1.82; 95% CI, 1.16-2.85), hypertension (HR 1.67; 95% CI, 1.04-2.67), and acute infarction on brain imaging (HR 1.84; 95% CI, 1.17-2.91) were significant predictors for the primary outcome. In the subgroup analysis, none of the blood inflammatory biomarkers were associated with CV events. Conclusions. The risk of CV events was highest during the first year after TIA, with a lower but sustained risk throughout the follow-up. This emphasizes the importance of both early initiation of and long-term continuation of secondary preventive treatment after TIA. Inflammatory biomarkers are probably not important as prognostic markers of cardiovascular disease in TIA patients.