TIA- Is There Increased Risk of Coronary Heart Disease? Berelind G. Libungan stud, med"

PURPOSE: Transient Ischémie Attack (TIA) predisposes the patient to stroke. It has been suggested that coronary artery disease (CAD) is the main cause of mortality in patients with history of TIA, but controlled studies are lacking. The objective of this study is to determine the risk for CAD (myocardial infarction or coronary artery death) in TIA patients and compare it to the risk for CAD in patients presenting with angina pectoris (AP) and in subjects who have neither experienced TIA nor CAD. METHODS: The participants were 4433 males who entered The Reykjavik Study in 1974 to 1977. All answered a detailed questionnaire, designed to detect symptoms suggestive of a TIA. All of the males who answered any of the questions positively were examined by a neurologist. Similarly the diagnosis of AP was established by help of a screening questionnaire (Rose) and the diagnosis was then confirmed by a cardiologist. The diagnosis of TIA was established in 79 males (2%) and AP in 240 (5%). The study group (n=4433) was divided into three groups: I. Subjects with history of TIA but not CAD (n=61). II. Subjects with history of AP, but not TIA or MI (n=210). III. A control group of individuals without history of TIA, AP or MI (n=4003). The proportional hazard analysis was used to establish differences between the two case groups (1, 11) and the control group (III) in number of deaths from CAD and also for myocardial infarction (fetal or non-fatal). Adjustments were made for age. The mean follow-up was 17. 8 years RESULTS: The patients with TIA had increased risk of death due to CAD 13% compared with 9% in the control group; Relative risk (RR) 1. 3 (95%CI 0. 6-2. 5). The patients with TIA subsequently developed MI in 30% of cases, compared with 17% of the controls; RR 1. 7(95%CI 1. 1-2. 7). The patients with AP had increased risk for coronary artery death, RR 3. 4 (95%CI 2. 64. 4); and increased risk for MI (fatal or non-fetal), RR 2. 6 (95%CI 2 1-3. 3) CONCLUSIONS: TIA is a significant risk factor for subsequent fatal and non-ratal myocardial infarction. The risk for subsequent coronary artery death is increased in individuals with history of TIA, but did not reach statistical significance. The risk for coronary artery morbidity and mortality in subjects with history of TIA is increased was not as increased as in subjects with history of angina pectoris.