Stroke survivors at higher risk for another stroke or heart attack for years longer than commonly thought

When someone survives a stroke or mini-stroke, they're at substantial risk of another stroke or admission to a long-term care facility for at least five years afterward, Canadian neurologists say.

A stroke happens when blood stops flowing to part of the brain. Doctors and researchers have tended to focus on complications in survivors for 90 days after a stroke.

Now there could be reason to expand that time span and broaden the medical supports and encouragement of healthy lifestyle choices to more stroke survivors.

Neurologist Dr. Richard Swartz and his team at Sunnybrook Health Sciences Centre in Toronto analyzed a decade's worth of discharge records for stroke patients in Ontario. They compared those cases with healthy controls of the same age, sex, income level and geographic area.

Patients who survive stroke or a transient ischemic attack (often called a mini-stroke) with temporary blockages in the brain "remain at substantial long-term risk, particularly for recurrent stroke and admission to institution," Swartz and his co-authors wrote in Monday's issue of the Canadian Medical Association Journal.

Among the more than 26,000 patients who were initially stable after a stroke or mini-stroke, the hazard of another stroke, heart attack, hospital admission, admission to an institution or death was more than double at one year, three years and five years compared with controls.

"I was surprised at the magnitude of the outcomes," Swartz told CBC News. "This actually has shifted my mindset a little bit to say 'we really need to think about this more like a chronic disease.'"

Much of recurrence preventable

The findings have important implications for providing people with supportive services after a stroke or mini-stroke, Swartz said, including making sure they maintain long-term lifestyle changes and continue taking the appropriate medication.

At five years, nearly eight per cent of patients had experienced another stroke, compared with 1.6 per cent of the controls, noted Dr. Michael Hill, a neurologist at the University of Calgary and Foothills Medical Centre, who wrote a journal commentary published with the study.

In the last 10 to 20 years, stroke specialists have focused on treatment and outcomes in up to the first six months after a stroke, Hill said.

"Typically patients have then discharged back to community care," Hill said in an interview. "The value of this article is to refocus attention and say, you know what? These people need some longer-term attention because their rates of recurrence advances and much of it is preventable."

Hill boils the dietary prevention strategies down to three points:

- Eat a sensible diet of mostly fruits and vegetables.

- Stick to unprocessed foods.

- Don't eat too much.

General health advice — don't smoke, stay physically active and minimize drinking — also applies to people who've had a stroke or mini-stroke.

"How do you get half the population to eat properly? How do you get everybody to exercise? These are much broader questions than just stroke," said Hill.

'Drove home looking out of one eye'

One of the limitations of the study is that the researchers didn't have information on the causes of stroke from the registry data.

Ron LaCombe, 64, has given up junk food, cut back on sugar and exercises more to reduce the risk of having another stroke. It manifested with some slurred speech, "goofy" vision and sluggishness on the right side during his shift as a public transit driver in Toronto in 2012.

"Drove home looking out of one eye, got home, lay down, and my wife came in and said, 'You're going to the doctor,'" LaCombe said.

Scans showed grey spots throughout his brain. What he had thought were migraines were probably mini-strokes, his doctors said.

"You get all of the signs and you figure that's for old people. Not me," LaCombe recalled. "Maybe if I'd have paid more attention, we would have got to it earlier."

To recognize the most probable signs of stroke, remember the acronym FAST:

- Face — Is it drooping?

- Arms — Can you raise both?

- Speech — Is it slurred or jumbled?

- Time — To call 911 right away.

The study was supported by the Institute for Clinical and Evaluative Sciences, which is funded by the Ontario Ministry of Health and Long-Term Care.