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Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis

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Abstract

Background

Stroke is still the main cause of death and disability worldwide, numerous studies of recurrence risk have been reported, while systematic estimates of stroke recurrence risk in the last 10 years are variable. This review aims to estimate the cumulative stroke recurrence risk in the last 10 years for secondary prevention management in future.

Methods

A systematic search from January 2009 to March 2019 was conducted through PubMed, EMBASE, Web of Science, Wan-fang, and CNKI. Search terms were in English and Chinese.

Results

A total of 37 studies involving 1,075,014 stroke patients were included. The pooled stroke recurrence rate was 7.7% at 3 months, 9.5% at 6 months, 10.4% at 1 year, 16.1% at 2 years, 16.7% at 3 years, 14.8% at 5 years, 12.9% at 10 years, and 39.7% at 12 years after the initial stroke. In addition, the pooled recurrence rate of 32 studies including stroke patients over 50 years only at seven time points except for subgroup of 10 years was 7.7%, 9.5%, 11.2%, 16.1%, 19.3%, 18.1%, and 39.7%, respectively. Meta-regression showed that the time points explained 23.02% of the variance among studies, while regions, age, and stroke types showed no significant contribution to heterogeneity.

Conclusions

The risk of stroke recurrence varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup. The heterogeneity may be explained by follow-up time, regions, age, methodology differences, and stroke types, which was needed further exploration in future.

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Acknowledgments

We would like to thank statisticians Professor Ping Zhi-guang and MD student Pei Xiao-ting for their guidance in the meta-analysis process. We also would like to thank PhD student Tong Yao for her help in draw figure by means of Python software.

Funding

This study was funded by the Foundation of National Key Program of Research and Development of China (2016YFC0900803), Educational Department of Henan Province (2018-ZZJH-547), and Health Commission of Henan Province (SBGJ2018052).

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Authors and Affiliations

  1. Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China

    Beilei Lin, Zhenxiang Zhang, Yongxia Mei, Hui Xu, Lamei Liu & Wenna Wang

  2. Academic of Medical Science, Zhengzhou University, Zhengzhou City, Henan Province, China

    Beilei Lin

  3. Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou City, Henan Province, China

    Chongjian Wang

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LBL had the idea for the article, performed the literature search and data analysis, MYX performed the data analysis, LBL drafted the work, MYX, WCJ, LLM, XH, and WWN edited the manuscript and ZZX revised the manuscript. All authors checked, interpreted results and approved the final version.

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Lin, B., Zhang, Z., Mei, Y. et al. Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis. Neurol Sci 42, 61–71 (2021). https://doi.org/10.1007/s10072-020-04797-5

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