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European Heart Journal Advance Access published online on June 3, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn232
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Stroke is a coronary heart disease risk equivalent: implications for future clinical trials in secondary stroke prevention

Pierre Amarenco1,2,* and Philippe Gabriel Steg1,3

1 INSERM U-698 and Denis Diderot University—Paris VII, France
2 Department of Neurology and Stroke Centre, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018 Paris, France
3 Department of Cardiology, Bichat-Claude Bernard University Hospital, Paris, France

* Corresponding author. Tel: +33 1 4025 8726, Fax: +33 1 4025 7198, Email: pierre.amarenco@bch.aphp.fr

The first 10% of the full text of this article appears below.

With an estimated 1 million cases per year in Europe, 1.2 million in North America, and 10 millions in the rest of the world, the burden of stroke is enormous. Stroke includes brain haemorrhage, transient ischaemic attacks (TIAs), and cerebral (brain) infarction (each of these causes accounting for approximately 15, 15, and 70% of cases, respectively).1,2 Overall, a quarter of all stroke patients has a history of a symptomatic coronary event.3 These patients are prone to recurrent coronary heart disease (CHD) events. In the PROGRESS trial, in the subset of patients with recent stroke and a history of CHD, the risk of a new CHD event was as high as the risk of a new stroke,4 but in the remainder of stroke patients without overt CHD, the risk . . . [Full Text of this Article]


   After a stroke/transient ischaemic attack, patients are at high risk of short-term non-fatal stroke and of long-term fatal coronary heart disease
 

   Coronary heart disease is highly prevalent at autopsy in patients with stroke/transient ischaemic attack
 

   Recent studies confirmed 10-year incidence of coronary heart disease in patients with stroke/transient ischaemic attack is 20%
 

   Secondary prevention trials should not only focus on the first 2–3 years
 

   Two long-term (4–5 years) secondary prevention trials showed reduction in coronary heart disease events
 

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