Predictors of Recurrent Stroke in Patients with First-Ever Acute Ischemic Stroke: A Prospective Single-Institute Study

As previous research has suggested that recurrent stroke (RS) adversely affects the life of survivors of ischemic stroke (IS), we aimed to assess the relationship between RS and the potential risk factors in patients with first-ever IS. We prospectively studied consecutive patients with first-ever acute ischemic stroke (AIS) who were admitted within the first 7 days of onset to the Acute Stroke Unit at the Guangdong Second Provincial General Hospital between November 2012 and January 2014. We recorded demographic factors, vascular risk factors, previous Rankin scale score, and etiology. The association between stroke recurrence and its risk factors was analyzed by using multivariable Cox regression model. Out of a total of 421 patients, 57 (13.5%) patients experienced RS during the follow-up period. Multivariable Cox regression analysis revealed that smoking [hazard ratio (HR), 2.153; 95% Confidence Interval (CI), 1.263-3.671], high density lipoprotein cholesterol (HDL) (HR, 0.438; 95% CI, 0.211-0.911), housework (HR, 0.488; 95% CI, 0.256-0.933), ischemic heart disease (IHD) (HR, 2.998; 95% CI, 1.281-7.020), daily consumption of fresh fruits (HR, 0.477; 95% CI, 0.278-0.819), and good sleep quality (HR, 0.375; 95% CI, 0.216-0.650) were associated with RS among stroke patients. Our results suggest that healthy lifestyle (high fruit intake, smoking cessation, housework, good sleep quality), higher HDL levels, and absence of IHD were associated with a lower risk of RS in patients with first-ever IS. Funding Statement: This work was partially supported by the Science and Technology Program of Guangzhou, China (201707010436 to ZXH), Guangdong Second Provincial General Hospital Medical Scientific Research Projects (YY2016-005 to ZXH), and Administration of Traditional Chinese Medicine of Guangdong Province, China (20173024 to XTL; 20181012 to ZXH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol was approved by the Ethical Committee of the Guangdong Second Provincial General Hospital.