Cerebrovascular Disease and its Relationship to Other Vascular Beds: A Comprehensive Review of the Literature

Atherothrombosis, ischaemic heart disease (IHD), cerebrovascular disease (CVD) and peripheral arterial dis- ease (PAD) are a major cause of mortality and are predicted to be the leading cause of death world-wide by 2020. It is now recognised that CVD is part of a family of atherothrombotic diseases such as PAD and IHD. However, despite receiving contemporary evidence-based preventative drug therapy, patients with established arterial disease and those with multiple risk factors for atherothrombosis both experience high cardiovascular (CV) event rates with a 4.7% yearly rate of hard events. People with symptomatic atherosclerosis in 1 vascular bed are at a higher risk of subsequent events in other beds, e.g. patients who suffer a stroke are at a high risk of going on to suffer a coronary event, with a 10 year CV event risk of 42.8%. These findings support the need for increased awareness among physicians and patients for the amount of vascular cross-risk that is related to the overlap between the various beds of atherothrombosis. Atherothrombosis in stroke patients should be considered as a global arterial disease. We present a systematic review of the literature relating to the risk of non-cerebral (especially sub-clinical) atherothrombotic events in ischaemic stroke pa- tients.