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High Risk of Stroke Shortly After a Heart Attack

Last Reviewed on: January 23, 2006

Advances in heart attack treatment in recent years have meant that not only are more people surviving, but fewer are suffering second attacks or complications like heart failure.

Despite this, though, heart attack patients are not yet out of the woods when they leave the hospital. In fact, recent research suggests they face a surprisingly high risk of suffering a stroke.

In a study published late last year in the Annals of Internal Medicine, researchers found that the risk of stroke is exceptionally high within the first month of heart attack recovery.. The results came as a shock to the researchers, who expected that successful methods used to protect against further heart trouble would also offset the risk of stroke since the two share many similar causes.

"This is not the finding we anticipated." said Dr. Veronique Roger, a Mayo Clinic cardiologist who led the study.

Still, Roger is quick to point out that the results do not undermine the use of current heart disease treatments. That’s because there has been considerable progress in keeping people alive after a heart attack, with the rate of heart failure and second heart attacks showing steep declines.

Aggressive treatment should be a priority, according to Roger. "The sooner you get treated for a heart attack, the better." she said.

To determine stroke risk following a heart attack, Roger’s team reviewed the medical records of over 2,100 patients who suffered a heart attack and were hospitalized at the Mayo Clinic in Rochester, Minnesota, between 1978 and 1998.

The patients were followed for an average of six years after their heart attack, and during that time, 273 of them suffered a stroke.

A high proportion of these strokes occurred within the first month of the heart attack, translating to a risk 44 times greater than what’s seen in the general population. The patients’ stroke risk remained higher than expected for the next three years.

Although the reasons for the higher risk are still unclear, Roger says that one explanation may be that the doctors and patients did not do enough to keep heart problems in check.

"How aggressive were doctors in implementing medications, and how faithful were patients in taking them?" she asked. "We don’t know yet." Roger continued, adding that she and her colleagues are pursuing those questions in further studies.

For now, she suggests that doctors may want to reconsider using blood thinning drugs, like warfarin, after a heat attack even though there are concerns about using such medications because of bleeding risks. They are one of the few treatments to show a clear benefit for preventing further heart attacks, as well as stroke.

"You would have to balance the concern of stroke with the risks of bleeding." Roger said.

What matters most, Roger added, is sticking to the treatment and lifestyle changes that can keep heart disease under control.

"These are lifelong measures that work." she said.