Effect of coexisting vascular disease on long-term risk of recurrent events after TIA or stroke

Objective:To determine whether TIA or ischemic stroke patients with co-existing cardiovascular disease (i.e. history of coronary or peripheral artery disease) are still at high risk of recurrent ischemic events despite current secondary prevention guideline. Methods: In a population-based study in Oxfordshire, United Kingdom (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002-2014. Patients were treated according to current secondary prevention guidelines and we determined risks of coronary events, recurrent ischemic stroke, and major bleeding stratified by the presence of co-existing cardiovascular disease. Results: Among 2555 patients (9148 patient-years of follow-up), those (n=640; 25.0%) with co-existing cardiovascular disease (449 coronary only; 103 peripheral only; 88 both) were at higher 10-year risk of coronary events than those without (22.8%; 95%CI 17.4-27.9; versus 7.1%, 5.3-8.8; p<0.001, age-and sex-adjusted HR=3.07, 2.24-4.21) an...