Impact of living and socioeconomic characteristics on cardiovascular risk in ischemic stroke patients


  • Conflict of interest: Dr. Amarenco has received research funding from Pfizer, AstraZeneca, Merck, Sanofi-Aventis, and BMS; speaker fees from Pfizer, Sanofi-Aventis, Bayer, Boehringer-Ingelheim, AstraZeneca, and Otsuka Pharmaceutical; and honoraria from Pfizer, Sanofi-Aventis, Bristol-Myers Squibb, Merck, Kowa, Lundbeck, Boston Scientific, Edwards, Bayer, and Boehringer-Ingelheim.
  • Dr. Abboud has no conflicts of interest to disclose.
  • J. Labreuche has no conflicts of interest to disclose.
  • Dr. Arauz has received speaker fees from Boehringer-Ingelheim and Pfizer.
  • Dr. Bryer has received research funding from Sanofi-Aventis, Boehringer-Ingelheim, Novartis, MSD, Solvay Pharmaceuticals, UCB, and GlaxoSmithKline and consulting/speaking fees from Boehringer-Ingelheim, Bayer, and Sanofi-Aventis.
  • Dr. Lavados has received research funding from the George Institute for Global Health, Lundbeck, Boehringer-Ingelheim, and Bristol-Myers Squibb and sits on the advisory boards of Bristol-Myers Squibb and Sanofi-Aventis.
  • Dr. Massaro has received speaker fees from Sanofi-Aventis, Boehringer-Ingelheim, Bayer, Ferrer Group, and Novartis.
  • Dr. Munoz Collazos has received research funding from Sanofi-Aventis, PROCAPS, and Biotoscana; speaker fees from Bayer Colombiana, Boehringer-Ingelheim, and Ferrer Group; honoraria from Bristol-Myers Squibb and Boehringer-Ingelheim; and travel and educational funding from Ferrer Group, Lundkeck, Sanofi-Aventis, Boehringer-Ingelheim, Tecnofarma, Bayer Colombiana, and Biotoscana.
  • Dr. Steg is supported by a research grant to INSERM U-698 from the New York University School of Medicine. He has received research funding from Sanofi and Servier and consulting/speaking fees from Ablynx, Amarin, Amgen, Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Daiichi Sankyo, Eisai, GlaxoSmithKline, Lilly, Medtronic, MSD, Novartis, Otsuka, Pfizer, Roche, Sanofi, Servier, The Medicines Company, and Vivus. He holds stock in Aterovax.
  • Dr. Yamout has received honoraria for presentations at medical conferences from Novartis, Biogen Merck-Serono, Bayer, and Pfizer.
  • Dr. Vicaut has received consulting/speaking fees from Abbott, Amgen, Bristol-Myers Squibb, Fresenius, GlaxoSmithKline, Medtronic, Pfizer, Sanofi, and Stallergenes.
  • Drs. Amarenco, Arauz, Bryer, Lavados, Massaro, Munoz Collazos, Steg, Yamout, and Vicaut received honorarium fees as members of the OPTIC steering committee.
  • Funding: The OPTIC registry is supported by Sanofi-Aventis, Paris, France. Sanofi-Aventis was not involved in the design of the study, analysis and interpretation of the data, or preparation and review of the manuscript, but provided help in the conduct of the study, did the data managing and collection of data, and gave its final approval for submission of the manuscript.



We aimed to stratify the risk of vascular event recurrence in patients with cerebral infarction according to living and socioeconomic characteristics and geographic region.


The Outcomes in Patients with TIA and Cerebrovascular Disease (OPTIC) study is an international prospective study of patients aged 45 years or older who required secondary prevention of stroke [following either an acute transient ischemic attack, minor ischemic strokes, or recent (less than six-months previous), stable, first-ever, nondisabling ischemic stroke]. A total 3635 patients from 245 centers in 17 countries in four regions (Latin America, Middle East, North Africa, South Africa) were enrolled between 2007 and 2008. The outcome measure was the two-year rate of a composite of major vascular events (vascular death, myocardial infarction and stroke).


During the two-year follow-up period, 516 patients experienced at least one major cardiovascular event, resulting in an event rate of 15·6% (95% confidence interval 14·4–16·9%). Event rates varied across geographical region (P < 0·001), ranging from 13·0% in Latin America to 20·7% in North Africa. Unemployment status, living in a rural area, not living in fully serviced accommodation (i.e., house or apartment with its own electricity, toilet and water supply), no health insurance coverage, and low educational level (less than two-years of schooling) were predictors of major vascular events. Major vascular event rates steeply increased with the number of low-quality living/socioeconomic conditions (from 13·4% to 47·9%, adjusted P value for trend <0·001).


Vascular risk in stroke patients in low- and middle-income countries varies not only with the number of arterial beds involved but also with socioeconomic variables.