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(Reference retrieved automatically from SciELO through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

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

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Author(s):
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A.C. Goulart [1] ; A.C. Varella [2] ; G. Tunes [3] ; A.P. Alencar [4] ; I.S. Santos ; C. Romagnolli [6] ; T.E. Gooden [7] ; G.N. Thomas [8] ; G.Y.H. Lip ; R.D. Olmos ; P.A. Lotufo ; I.M. Bensenor
Total Authors: 12
Affiliation:
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[1] Universidade de São Paulo. Hospital Universitário. Centro de Pesquisa Clínica e Epidemiológica - Brasil
[2] Universidade de São Paulo. Hospital Universitário. Centro de Pesquisa Clínica e Epidemiológica - Brasil
[3] Instituto de Matemática e Estatística, Universidade de São Paulo - Brasil
[4] Instituto de Matemática e Estatística, Universidade de São Paulo - Brasil
[6] Universidade de São Paulo. Hospital Universitário. Centro de Pesquisa Clínica e Epidemiológica - Brasil
[7] Institute for Applied Health Research, University of Birmingham - Reino Unido
[8] Institute for Applied Health Research, University of Birmingham - Reino Unido
Total Affiliations: 12
Document type: Journal article
Source: Brazilian Journal of Medical and Biological Research; v. 56, 2023-09-22.
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. (AU)

FAPESP's process: 18/05512-3 - PROGNOSTIC FACTORS ASSOCIATED WITH MORTALITY AND SURVIVAL UP TO 12 YEARS OF FOLLOW-UP IN THE MORTALITY AND MORBIDITY STROKE STUDY (EMMA STUDY).
Grantee:Alessandra Carvalho Goulart
Support Opportunities: Regular Research Grants