May 2025
Reducing the risk of recurrent stroke: ‘not a sprint, but a marathon’
By Rebecca Jenkins
Patients who have had a transient ischaemic attack (TIA) or minor stroke are at a persistently high risk of subsequent stroke for the next 10 years, a large study finds.
The risk of a subsequent stroke was known to be high in the first 90 days after a TIA or minor stroke, researchers wrote in JAMA, but the long-term prognosis of these patients was not clear.
To address this knowledge gap, the international team of clinicians conducted a systematic review and meta-analysis of 171,068 patients (median age, 69 years; 57% male) with TIA or minor stroke from 38 studies. They found the annual risk of stroke decreased from 5.9% in the first year to an average of 1.8% per year for subsequent years. However, the cumulative risk of stroke continued to increase over time, with the five-year cumulative incidence of stroke 12.5% and the 10-year cumulative incidence 19.8%.
The study confirmed the first three months after a TIA or minor stroke as the highest risk period, with 61.7% of subsequent strokes in the first year occurring in the first 90 days. Nevertheless, the data also revealed that over 10 years’ follow up, half of all subsequent stroke events happened after the first year.
Study coauthor Professor Christopher Levi, Stroke Neurologist at the John Hunter Hospital and Conjoint Professor of Medicine at the University of Newcastle, Newcastle, said there were very little data available about the long-term risk of recurrent stroke after TIA or minor stroke.
‘It is common to see that patients might become more complacent with their risk-factor control years after the initial event – the data from this study tell us that shouldn’t be the case,’ he told Medicine Today.
Coauthor Associate Professor Carlos Garcia-Esperon, Stroke Neurologist at the John Hunter Hospital and Conjoint Associate Professor at the University of Newcastle, added that sometimes TIA or minor strokes were wrongly interpreted and/or dismissed as mild conditions or simply a ‘funny turn’.
‘However, they are not trivial events and their risk is enduring. As we can see in this study, the risk of a re-event remains high even five to 10 years after the index event,’ he said.
The data reaffirmed the important role GPs had in managing this population, particularly in monitoring long-term vascular risk factors.
‘Traditionally most patients are discharged from subspecialised stroke clinics around three months from the index event – hence the need for care in general practice,’ Associate Professor Garcia-Esperon said.
‘Stroke care community services offering physical exercise and activities and vascular risk factor control beyond the initial three months are also crucial. We have this in Newcastle and they do an excellent job.’
Given one in five patients were at risk of having another stroke within 10 years after the initial TIA or minor stroke, there was a substantial opportunity to decrease the risk of recurrent stroke through good long-term control of vascular risk factors.
‘Reducing the risk of recurrent stroke is not a sprint, as we thought, but a marathon,’ he said.