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From the Departments of Neurology and Epidemiology (Dr. Longstreth), University of Washington, Seattle; Department of Neurology (Dr. Bernick), University of California, Davis; CHS Coordinating Center (Dr. Fitzpatrick), University of Washington, Seattle; Department of Medicine (Dr. Cushman), University of Vermont, Burlington; Department of Neurology (Dr. Knepper), University of Pittsburgh, PA; Department of Medicine, Division of Cardiology (Dr. Lima), Johns Hopkins University, Baltimore, MD; and Department of Public Health Sciences (Dr. Furberg), Wake Forest University, Winston-Salem, NC.
Address correspondence and reprint requests to Dr. W.T. Longstreth, Jr., Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle WA 98104-2499; e-mail: wl{at}u.washington.edu
BACKGROUND: Few population-based studies have examined in detail issues of stroke-related deaths in elderly people.
METHODS: Participants in the Cardiovascular Health Study (CHS) are 65 years of age or older, have had extensive baseline evaluations, and have been followed-up for fatal and nonfatal cardiovascular and cerebrovascular disease outcomes. Investigators adjudicated these outcomes and classified strokes by types and subtypes.
RESULTS: Over 7 years, 1,310 (22.2%) of 5,888 participants died, and 455 (7.7%) experienced incident stroke. For the 5,888, stroke mortality was 3.2 per 1,000 person-years. For the 455, it was 36.1 per 1,000 person-years, with the most lethal type being hemorrhagic and the ischemic subtype being cardioembolic. After controlling for age and stroke type, the only other independent predictor of death after any stroke was poor performance on a timed walk measured before the incident stroke. Considering only ischemic stroke, the independent predictors of death were African American race and poor performance on timed walk.
CONCLUSION: In CHS, death attributable to stroke is common. As in other studies, the most lethal stroke type was hemorrhagic, and ischemic stroke subtype, cardioembolic. Slow walking, possibly a measure of frailty, was associated with an increased risk of death of stroke. Finally, African Americans faced a greater risk of death than others after an ischemic stroke.
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