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Student thesis: Doctoral ThesisDoctor of Philosophy

Background - The natural history, predictors and outcomes of stroke
recurrence after first-ever stroke have been insufficiently investigated. The
available evidence shows great variation and does not provide a consensus of
key predictors of stroke recurrence or a critical time-period for stroke
recurrence occurring after initial stroke. This thesis uses data collected from
the population-based South London Stroke Register to estimate the natural
history of stroke recurrence after first-ever stroke.
Methods - Data were collected over 12 years from all individuals known to
have had an initial and first recurrent stroke from the South London Stroke
Register. The cumulative risk and predictors of stroke recurrence up to 12
years after first stroke were identified using survival analyses, taking into
account the effect of temporal changes in stroke management. The effect of
stroke recurrence on risk of death after first stroke was estimated up to 15
years after initial stroke. A systematic review and meta-analysis of studies of
the risk and cumulative risk of stroke recurrence after first stroke was also
Results - The risk of stroke recurrence was estimated to be up to 25% at 12
years after first stroke. Cardiovascular risk factors were found to be important
predictors of stroke recurrence, however differences in risk of recurrence were
noted between the aetiological subtypes. Stroke recurrence was
demonstrated to increase risk of death at all time-points up to 15 years after
first stroke.
Conclusions – The risk of stroke recurrence is considerable and is associated
with increased risk of death up to 15 years after first stroke. Further research
is needed to examine the effect of secondary prevention on risk of recurrence.
Recurrence in the first year after stroke may also be associated with the
biggest increase in risk of death identifying a potentially important time-period
for stroke management to be targeted.
Original languageEnglish
Awarding Institution
Award date2016


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