P5352The main characteristics and multimorbidity in patients with history of stroke, myocardial infarction and their combination (hospital registry data)
Authors: Okshina E Y , Lukiyanov M M , Drapkina O M , Klyashtorny V G , Kudryashov E V , Belova E N , Deev A D , Makoveeva A N , Boytsov S A 
Published: October 2019

Abstract

Aim
To assess characteristics and patterns of cardiovascular (CV) and non-cardiovascular (non-CV) multimorbidity in patients with history of stroke (STR) without myocardial infarction (STRH), history of myocardial infarction (MI) without stroke (MIH), and their combination (STRH+MIH) on a basis of the hospital registry.

Methods
The hospital registry included 8954 patients with arterial hypertension (AH), ischemic heart disease, chronic heart failure (CHF), atrial fibrillation (AF) and their combinations hospitalized to the National Medical Research Center for Preventive Medicine (Moscow, Russia) from 01.04.13 to 31.03.17. 2020 (22.6%) patients had a MIH, 857 (9.6%) – a STRH and 318 (3.6%) had a combination of them.

Results
The age of patients with MIH was significantly less than in STRH and in the combined group (66.8±11.3 vs 70.8±10.9 and 71.6±9.9 years, p<0.05). 70% of patients in STRH+MIH group had primary MI earlier than STR (on the average 3.8 years). The age of primary MI and STR was 61.3±11.4 and 65.8±11.7 years respectively (p<0.001). 27% of all STRH and 14% of MIH cases were presented in MIH+STRH group. Men prevailed in MIH and MIH+STRH (70% and 64.5%) groups, women – in STRH (59%). In MIH group compared with STRH and STRH+ MIH groups was lower frequency of AH (90.2% vs 97.2%; 96.5%) and AF (21.2% vs 41.5%; 41.5%). CHF patients prevailed in STRH+MIH and MIH groups (70.4%; 57.1% vs 40.7%), p<0.0001. The most number of CV diseases (CVDs) was in STRH+MIH group (3.09±0.8) and less in MIH (2.9±1.0) and STRH (1.96±0.9) groups. In STRH+MIH patients compared with STRH and MIH groups were also more often identified: diabetes (35.2%; 22.3%; 24.7%, p<0.0001), digestive diseases (80.2% vs 73.4%; 75.6%, p<0.0001 and p=0.025), kidney diseases (56.6% vs 44,7%; 29%, p<0.0001 and p=0.0003), respiratory diseases (37.4% vs 23.9%; 31.9%, p=0.005; p=0,001), anemia (12.9% vs 7.9% and 6.9%, p=0.0002 and p=0.009). The number of obese patients did not differ significantly in all groups (33.0%; 30.7%; 28.1%, p>0.05). The average number of comorbid non-CV diseases (non-CVDs) was: 1.96±0.5 in MIH group; 2.03±0.3 in patients with STRH and 2.55±0.3 in STRH+MIH group (p<0.05, adjusted to age and sex). The total number of CVDs and non-CVDs was maximal (5,6) in STRH+MIH group, less in MIH (4.65) and STRH (3,99) groups.

Conclusions
Patients with history of stroke and myocardial infarction had maximal number both of CVDs and non-CVDs compared with groups of only myocardial infarction or stroke history, i.e. they had the higher CV risk and the most unfavorable profile in hospital registry. So, the multidisciplinary approach for the treatment and prevention in this multimorbid group is most indicated. 70% of patients in combined group had primary MI earlier than primary stroke (on the average 3.8 years). This fact confirmed the suggestion that MI is the earlier part of cardiovascular continuum than stroke.