Tuesday, 17 April 2018

Patients with a Diagnosis of Malignant Cancer First After Tia/Stroke Usually Appear to Have Lower Annual Risk of Stroke/Myocardial Infarction Events Compared to Patients Without Cancer Diagnosis. A 25-Year Follow-Up Hospital-Based Observational Study

Cancer can increase the risk of stroke due to multiple causes especially during the first 3-6 months after diagnosis for lung, pancreatic, colorectal, breast, prostate cancers or with diagnosed cancer in the nervous system or leukaemia. The occurrence of metastasis is associated with an increased risk of haemorrhagic/ischaemic stroke. In patients with cancer in the nervous system, colon, rectum, urinary bladder or leukaemia, an increased risk of ischemic stroke has been found even during long-term observation as for women with breast cancer. Radiotherapy has been reported to be a risk factor for stroke as well as for myocardial infarction (MI), whereas treatment with tamoxifen has been reported to increase the risk of stroke but to decrease the risk of MI. 

Charturwedi et al. declared that the identified ischaemic strokes among cancer patients were low and that the rate of recurrent ischaemic events, which occurred in 6% of cancer patients during a mean observation of 9 months, was not higher than the results from different stroke studies reported. However, in a Chinese stroke study past cancer was shown by Cox regression analysis to be a predictor of recurrent stroke as well as cardiovascular mortality during longterm follow-up. The main purposes of this retrospective study were to determine whether patients admitted due to transient ischaemic attack (TIA) or different subgroups of stroke with a diagnosis of malignant cancer (International Classification of Disease (ICD), ICD-10: C00-C97) either before and/or after admission had different risks of recurrent stroke and MI annually compared to patients without cancer.

This study consists of a cohort of 549 patients who had been hospitalized in the Stroke Unit or on the general ward of the Department of Neurology, University Hospital Linköping in 1986 and retro/prospectively followed up until Feb. 2011. The definitions of risk factors have been reported previously. Cause of death was based on the underlying cause, defined by the World Health Organization (WHO) as the disorder that began the chain of events leading to death. Data about types of cancer were obtained from the Swedish Cancer Registry established in 1958 and with data to 2010, with permission from the National Board of Health and Welfare, Stockholm, Sweden as well from journals and autopsy reports. Patients with basal cell carcinoma were not included in this report because basal cell carcinoma was not included in the Swedish Cancer Registry until 2004. Stage of cancer or cancer treatment was not reported. 

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