OBJECTIVES : Estimate rates of major cardiovascular events (MACE) in patients with a history of ischemic stroke (IS) in Sweden.

METHODS : Retrospective population-based cohort study using Swedish national registers from 1-July-2001 to 31-December-2015. Patients treated with high/moderate-intensity statins with/without ezetimibe were included. Prevalent and incident IS cohorts were defined. Prevalent patients had a documented IS as of 1-July-2006 (and were followed thereafter). Incident patients had a documented IS between 1-July-2006 and 31-December-2014 (and were followed from the diagnosis date). Two subgroups were defined within both cohorts to characterize patients with additional risk factors: diabetes mellitus with target organ damage (DM) and multiple events (two MACE within two years, the last one being an IS). A MACE endpoint, a composite of non-fatal myocardial infarction, non-fatal IS or cardiovascular death, was used in the analysis. Patients were followed until first event, death or end of follow-up. Rates of first MACE were calculated. Additionally, annual rates over time (incident cohort) and 10-year risks of first MACE (prevalent cohort) were calculated.

RESULTS : The rate of first MACE per 100 person-years was 12.3 in the incident IS cohort and 6.9 in the prevalent IS cohort (n=36,134 and 19,024, respectively). The rate was 17.2 (incident) and 9.9 (prevalent) in the DM subgroup (n=4,319 and 1,930, respectively); and 18.8 (incident) and 9.9 (prevalent) in the multiple events subgroup (n=3,022 and 2,422, respectively). Annual rates in the incident IS cohort were 23.1 in year 1 and 9.4 in year 2, while rates from year 3 onwards converged to the rate of the prevalent IS cohort. The 10-year risk of first MACE was 49.7% in the prevalent IS cohort (65.8% and 62.9% in the DM and multiple events subgroups, respectively).

CONCLUSIONS : Despite receiving treatment with high/moderate-intensity statins with/without ezetimibe, patients with a history of IS show a very high cardiovascular risk.