Stroke: age over 65 years and diabetes mellitus increased risk of stroke or death.

Clinical bottom line (level 1b)

  1. A quarter of patients with transient ischemia or a minor stroke had a further stroke or died within 2 years.
  2. Patients who had transient ischaemia or a minor stroke were at increased risk of stroke or death within two years if they were aged over 65 years old or had diabetes mellitus.
Kernan et al: Annals of Internal Medicine 1991; 114: 552-557
Expires June 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: community hospital, USA

142 patients (aged ?, 58% male) hospitalised, had carotid ultrasonography at the hospital the study was set in, had no previous symptomatic cerebrovascular event and had carotid transient ischaemic attack or carotid minor stroke

Excluded if
  • artificial heart valves



    • Factors studied:
  • stroke or death
  • age >65 years
  • diabetes mellitus




    • Cox proportional hazards regression model was used to adjust for confounding factors.

    followed for 2 years
    Outcomes studied:
  • stroke or death stroke defined as any new focal neurological deficit that resulted from a brain infarction or haemorrhage and that persisted for >24 hours

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    stroke or death 2 years 38/142 26.8%
    (19.5% to 34.0%)

    prognostic factor for
    stroke or death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    age >65 years 2 years 2.43
    (1.28 to 4.62)     		1
    (1 to 7)
    diabetes mellitus 2 years 2.38
    (1.41 to 4.00)     		3
    (2 to 11)

    Comments

    1. Comparison with another set of data showed that age of >65 years was a significant prognostic factor.

    Citation

    1. Kernan WN, Horwitz RI, Brass LM, et al: A prognostic system for transient ischemia or minor stroke. Annals of Internal Medicine 1991; 114: 552-557
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient transient ischaemic attack or minor stroke
    Intervention or Exposure older age, diabetes and hypertension
    Comparison none of these factors
    Outcome increase chance of stroke or death