Predictors of the one-year stroke recurrence in the Northern Manhattan Stroke Study

As a part of the community-based Northern Manhattan Stroke Study, 611 patients with first cerebral infarction were prospectively followed to detect the 1-year stroke recurrence. Baseline risk factors evaluated included age, gender, hypertension, diabetes, smoking, alcohol consumption, serum cholesterol, myocardial infarction, congestive heart failure (CHF), atrial fibrillation, and NIH Stroke Scale (NIHSS). Life tables were used to estimate the 1-year stroke recurrence risk, and a logistic multiple regression model to calculate relative risks and 95% CI one year after initial stroke. Among 94 (15%) patients with identified recurrence, 19% died within 1 year from the recurrent stroke. The life cable cumulative risk of recurrent stroke was 3% at day 30, 10% at 1 year, 14% at 2 years, and 18% at 3 years. The 1-year cumulative risk of recurrence did not significantly differ according to age (11% for >60 years; 5% for <60 years) or gender (men, 10%; women, 10%). The 1-year recurrence risk was significantly different for the baseline NIH stroke scale (NIHSS ≤3, 5%; 3-8, 14%; NIH >8, 7%; p = 0.019), and CHF (yes 17%, no 19%; p = 0.041). The logistic multiple regression model revealed age over 60 years, CHF, and alcohol consumption of >2 drinks/day to be independent predictors of 1-year stroke recurrence (age >60 RR 2.9, 95% CI 1.1-8.2; CHF RR 2.7, 1.3-5.5, alcohol >2/day RR 3.1 CI 1.2-8.1). Our data suggest a different pattern of risk factors for stroke recurrence than that for initial stroke. The patients who have already suffered first stroke should also be considered a target population for education, improvement of compliance with medical therapies, and modification of hazardous behaviors.