Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis

Abstract

Risk factors for first-ever stroke have been studied extensively, while those for recurrent stroke are not accurately understood. To provide the adequate secondary prevention for the patients, it is necessary to reveal the risk factors that dominate recurrent stroke. Multiple databases were adopted to search for the relevant studies and full-text articles involving in the risk factors for stroke recurrence were reviewed. Meta-analyses were performed with Review Manager 5.0 to estimate the impact of risk factors included, and forest plots, quality analysis and bias analysis for the articles included were also conducted. Finally 11 studies which eventually satisfied the eligibility criteria were included in this study, and patients with initial stroke and recurrent stroke were 14,455 and 1545, respectively. The meta-analyses showed that hypertension (OR = 1.67, 95%CI [1.45, 1.92], P < 0.00001), diabetes mellitus (OR = 1.50, 95%CI [1.30, 1.72], P < 0.00001), atrial fibrillation (OR = 1.88, 95%CI [1.56, 2.25], P < 0.00001) and coronary heart disease (OR = 1.77, 95%CI [1.31, 2.39], P = 0.0002) played a certain role in the process of stroke recurrence, while the influences of dyslipidemia (OR = 0.92, 95%CI [0.67, 1.27], P = 0.62) and smoking (OR = 0.96, 95%CI [0.80, 1.15], P = 0.62) were not significant. Hypertension, diabetes mellitus, atrial fibrillation and coronary heart disease of patients with stroke have statistical associations with recurrent stroke, and secondary prevention and treatment should be provided to curb the recurrence.

Keywords: Diabetes mellitus; Hypertension; Recurrence; Risk factors; Stroke.