Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: findings from the DIG stroke sub-study.

Abstract

BACKGROUND:

Little is known about the epidemiology of stroke in chronic systolic and diastolic heart failure (HF) patients in normal sinus rhythm (NSR) receiving angiotensin-converting enzyme (ACE) inhibitors. Because all HF patients in the Digitalis Investigation Group (DIG) trial (N=7788) were in NSR and nearly all were receiving ACE inhibitors, a survey-based stroke-sub-study was conducted but its findings have never been published.

METHODS:

DIG investigators confirmed a total 222 cases of stroke of which 144 had neurological deficit ≥24 h. We used logistic regression models to determine predictors of incident stroke among all 7788 patients and predictors of neurological deficit ≥24 h and all-cause mortality among 222 stroke patients.

RESULTS:

Age ≥65 years (adjusted odds ratio {AOR}, 1.36; 95% confidence interval {CI}, 1.02-1.80; P=0.035), nonwhite race (AOR, 0.65; 95% CI, 0.42-0.99; P=0.047), hypertension (AOR, 1.46; 95% CI, 1.11-1.94; P=0.008), diabetes mellitus (AOR, 1.37; 95% CI, 1.03-1.82; P=0.030), and cardiomegaly (AOR, 1.39; 95% CI, 1.03-1.86; P=0.030) were independent predictors of stroke. However, among those with stroke, nonwhites had higher odds of neurological deficits ≥24 h (AOR, 2.86; 95% CI, 1.01-8.07; P=0.047) and death (AOR, 3.28; 95% CI, 1.30-8.30; P=0.012).

CONCLUSION:

Older age, hypertension, diabetes and cardiomegaly were associated with increased incidence of stroke among HF patients with NSR receiving ACE inhibitors. The association of race and stroke, however, was complex. While nonwhite race was associated with decreased risk of stroke, among those with stroke, nonwhite race was associated with increased stroke severity and mortality.

• Authors: Marjan Mujib, Grigorios Giamouzis, Syed Abbas Agha, Inmaculada Aban, Nalini Sathiakumar, O James Ekundayo, Edward Zamrini, Richard M Allman, Javed Butler, Ali Ahmed
• Journal: International journal of cardiology (Int J Cardiol) Vol. 144 Issue 3 Pg. 389-93 (Oct 29 2010) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 19439379 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Ireland Ltd.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Alabama (epidemiology)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Cardiomegaly (epidemiology)
• Chronic Disease
• Confidence Intervals
• Diabetes Complications (epidemiology)
• Female
• Health Surveys
• Heart Failure (complications, drug therapy, epidemiology, mortality, physiopathology)
• Heart Rate
• Humans
• Hypertension (epidemiology)
• Incidence
• Male
• Odds Ratio
• Risk Factors
• Stroke (epidemiology, etiology, mortality)