Stroke: ischeamic heart disease and diabetes mellitus increased the risk of stroke in mitral valve prolapse.

Clinical bottom line (level 2b)

  1. A fiftieth of patients with mitral valve prolapse will have had a first-ever stroke within 10 years.
  2. Patients over the age of 35 years and having mitral valve prolapse were at an increased risk of first-ever stroke if they had ischaemic heart disease or diabetes mellitus.
Orencia et al: Stroke 1995; 26: 7-13
Expires December 2002

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population-based, USA

1079 patients (aged mean 44 years (at initial echocardigraphic diagnosis), 51% female) mitral valve prolapse diagnosed by echocardiography from January 1, 1975 to December 31, 1989, with no previous stroke or transient ischaemic attack

Excluded if
  • <15 years old when mitral valve prolapse diagnosed
  • inital echocardiographic diagnosis of mitral valve prolapse before 1975
  • mitral valve replacement or mitral valve surgery before or at the time of echocardiographic diagnosis of prolapse
  • cardiac transplantation



    • Factors studied:
  • first-ever stroke
  • ischaemic heart disease
  • diabetes mellitus




    • Multivariate analyses was used to adjust for confounding factors. Age, diabetes mellitus, ischaemic heart disease and congestive heart failure were all adjusted for.

    100% followed for 10 years
    Outcomes studied:
  • first-ever stroke

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    first-ever stroke 10 years 22/1079 2.04%
    (1.20% to 2.88%)

    prognostic factor for
    first-ever stroke     		time to outcome control rate (%) adjusted OR
    (95% CI)
    ischaemic heart disease ? 3.30
    (1.30 to 8.60)
    diabetes mellitus ? 4.60
    (1.20 to 17.2)

    Comments

    1. Analysis of prognostic factors was restricted to patients 35 years and older at the initial diagnosis of mitral valve prolapse, as the youngest person with prolapse who had a stroke was 47 at first stroke.
    2. Age was considered to be an independent factor, but no odds ratios were stated.
    3. No control event data was given, so NNF+s could not be calculated.

    Citation

    1. Orencia AJ, Petty GW, Khandheria BK, et al: Risk of stroke with mitral valve prolapse in population-based cohort study. Stroke 1995; 26: 7-13
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient no priot stroke or TIA
    Intervention or Exposure mitral valve prolapse
    Comparison no mitral valve prolapse
    Outcome first-ever stroke