Inclusion of Stroke in Cardiovascular Risk Prediction Instruments: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

• Published in: Stroke (1970) 2012-07, Vol.43 (7), p.1998-2027
• Main Authors: LACKLAND, Daniel T, ELKIND, Mitchell S. V, SMITH, Sidney C, TANNE, David, TIRSCHWELL, David L, TOUZE, Emmanuel, WECHSLER, Lawrence R, D'AGOSTINO, Ralph, DHAMOON, Mandip S, GOFF, David C, HIGASHIDA, Randall T, MCCLURE, Leslie A, MITCHELL, Pamela H, SACCO, Ralph L, SILA, Cathy A
• Format: Article
• Language: English
• Subjects: American Heart Association; Biological and medical sciences; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - therapy; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Health Personnel - standards; Humans; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Predictive Value of Tests; Risk Factors; Stroke - diagnosis; Stroke - epidemiology; Stroke - therapy; United States; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STR.0b013e31825bcdac

Current US guideline statements regarding primary and secondary cardiovascular risk prediction and prevention use absolute risk estimates to identify patients who are at high risk for vascular disease events and who may benefit from specific preventive interventions. These guidelines do not explicitly include patients with stroke, however. This statement provides an overview of evidence and arguments supporting (1) the inclusion of patients with stroke, and atherosclerotic stroke in particular, among those considered to be at high absolute risk of cardiovascular disease and (2) the inclusion of stroke as part of the outcome cluster in risk prediction instruments for vascular disease. Writing group members were nominated by the committee co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee and the AHA Manuscript Oversight Committee. The writers used systematic literature reviews (covering the period from January 1980 to March 2010), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard AHA criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive AHA internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. There are several reasons to consider stroke patients, and particularly patients with atherosclerotic stroke, among the groups of patients at high absolute risk of coronary and cardiovascular disease. First, evidence suggests that patients with ischemic stroke are at high absolute risk of fatal or nonfatal myocardial infarction or sudden death, approximating the ≥20% absolute risk over 10 years that has been used in some guidelines to define coronary risk equivalents. Second, inclusion of atherosclerotic stroke would be consistent with the reasons for inclusion of diabetes mellitus, peripheral vascular disease, chronic kidney disease, and other atherosclerotic disorders despite an absence of uniformity of evidence of elevated risks across all populations or patients. Third, the large-vessel atherosclerotic su