Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 22:56:e12895.
doi: 10.1590/1414-431X2023e12895. eCollection 2023.

Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

A C Goulart  1 , A C Varella  1 , G Tunes  2 , A P Alencar  2 , I S Santos  1   2   3 , C Romagnolli  1 , T E Gooden  4 , G N Thomas  4 , G Y H Lip  4   5   6 , R D Olmos  1   3 , P A Lotufo  1   3 , I M Bensenor  1   3
Affiliations

Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

A C Goulart et al. Braz J Med Biol Res. .

Abstract

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Functionality by the modified Ranking scale at 6 months after stroke in the Study of Stroke Mortality and Morbidity (EMMA) cohort.
Figure 2
Figure 2. Kaplan Meyer survival curve for all-cause mortality by sex among ischemic stroke patients during the 12-year follow-up in the Study of Stroke Mortality and Morbidity (EMMA) cohort.
Figure 3
Figure 3. Fixed baseline risk factors without time-dependent effect on all-cause mortality in the Study of Stroke Mortality and Morbidity (EMMA) cohort.
Figure 4
Figure 4. Fixed baseline risk factors with time-dependent effect on all-cause mortality in the Study of Stroke Mortality and Morbidity (EMMA) cohort.
See this image and copyright information in PMC

References

    1. Dekker FW, de Mutsert R, van Dijk PC, Zoccali C, Jager KJ. Survival analysis: time-dependent effects and time-varying risk factors. Kidney Int. 2008;74:994–997. doi: 10.1038/ki.2008.328. - DOI - PubMed
    1. Goulart AC, Olmos RD, Santos IS, Tunes G, Alencar AP, Thomas N, et al. The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: a 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity. Int J Stroke. 2022;17:48–58. doi: 10.1177/1747493021995592. - DOI - PubMed
    1. Tang Z, Zhou T, Luo Y, Xie C, Huo D, Tao L, et al. Risk factors for cerebrovascular disease mortality among the elderly in Beijing: a competing risk analysis. PLoS One. 2014;9:e87884. doi: 10.1371/journal.pone.0087884. - DOI - PMC - PubMed
    1. Castro HHG, Alencar AP, Benseãor IM, Lotufo PA, Goulart AC. Multimorbidities Are associated to lower survival in ischaemic stroke: results from a Brazilian Stroke Cohort (EMMA Study) Cerebrovasc Dis. 2017;44:232–239. doi: 10.1159/000479827. - DOI - PubMed
    1. Goulart AC, Fernandes TG, Santos IS, Alencar AP, Benseãor IM, Lotufo PA. Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort. BMC Neurol. 2013;13:51. doi: 10.1186/1471-2377-13-51. - DOI - PMC - PubMed