{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:13:44Z","timestamp":1791231224864,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,7]]},"abstract":"\n Background and Purpose\u2014<\/jats:title>\n Cerebrovascular, coronary, and peripheral vascular disease have common underlying arterial pathology and risk factors, but the clinical significance of multiple-territory disease in patients with transient ischemic attack (TIA)\/ischemic stroke is unclear, particularly whether the number of clinically affected territories still predicts long-term outcome on current standard secondary prevention therapies.<\/jats:p>\n <\/jats:sec>\n \n Methods\u2014<\/jats:title>\n In a population-based study of 92\u2009728 individuals in Oxfordshire, United Kingdom (Oxford Vascular Study), we studied patients presenting with TIA\/ischemic stroke (2002\u20132014) in relation to the number of other vascular beds (coronary, peripheral) affected by symptomatic (current or previous) disease. We compared the risk factor profile and long-term prognosis in patients with single- versus multiple-territory disease.<\/jats:p>\n <\/jats:sec>\n \n Results\u2014<\/jats:title>\n \n Among 2554 patients with 10\u2009679 patient-years of follow-up, 1842 (72.1%) had single- (TIA\/stroke only), 608 (23.8%) double-, and 104 (4.1%) triple-territory symptomatic vascular disease. The number of affected vascular beds increased with the number of atherosclerotic risk factors (\n P<\/jats:italic>\n trend<\/jats:sub>\n <0.0001). Compared with patients with TIA\/stroke only, those with multiple-territory disease had more hypertension (age\/sex-adjusted odds ratio [OR], 3.43; 95% confidence interval [CI], 2.76\u20134.27;\n P<\/jats:italic>\n <0.0001), diabetes mellitus (OR, 2.89; 95% CI, 2.27\u20133.66;\n P<\/jats:italic>\n <0.0001), hypercholesterolemia (OR, 4.67; 95% CI, 3.85\u20135.66;\n P<\/jats:italic>\n <0.0001), and current or previous smoking (OR, 1.52; 95% CI, 1.26\u20131.84;\n P<\/jats:italic>\n <0.0001). Triple-territory disease was particularly strongly associated with hypercholesterolemia (OR, 6.80; 95% CI, 4.39\u201310.53;\n P<\/jats:italic>\n <0.0001). Despite more intensive secondary prevention in patients with multiple-territory disease, the 5-year risk of vascular death increased steeply with the number of territories affected (17.2% versus 30.0% versus 42.9%;\n P<\/jats:italic>\n <0.0001). Compared with patients with single-territory, patients with multiple-territory disease also had higher postacute long-term risks (90 days to 10 years) of recurrent ischemic stroke (age\/sex-adjusted hazard ratio, 1.38; 95% CI, 1.04\u20131.81;\n P<\/jats:italic>\n =0.02) and nonstroke acute vascular events (hazard ratio, 3.06; 95% CI, 2.23\u20134.20;\n P<\/jats:italic>\n <0.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions\u2014<\/jats:title>\n Number of affected vascular beds appeared to be a simple clinical rule in identifying TIA\/ischemic stroke patients who are at high long-term risk of nonstroke vascular events and vascular death.<\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/strokeaha.118.020913","type":"journal-article","created":{"date-parts":[[2018,6,7]],"date-time":"2018-06-07T05:00:17Z","timestamp":1528347617000},"page":"1639-1646","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Long-Term Prognosis of Patients With Transient Ischemic Attack or Stroke and Symptomatic Vascular Disease in Multiple Arterial Beds"],"prefix":"10.1161","volume":"49","author":[{"given":"Mirjam R.","family":"Heldner","sequence":"first","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linxin","family":"Li","sequence":"additional","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola G.","family":"Lovett","sequence":"additional","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena M.","family":"Kubiak","sequence":"additional","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Lyons","sequence":"additional","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Rothwell","sequence":"additional","affiliation":[{"name":"From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Oxford Vascular Study","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31012-1"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000128519.60762.84"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000128517.52533.DB"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature10146"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061894"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67394-1"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60503-1"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01225-8"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707914"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615664"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706444"},{"key":"e_1_3_4_14_2","first-page":"1216","article-title":"Identifying patients with vascular disease at very high risk (VHR) for recurrent events according to the ACC\/AHA and ESC guideline criteria. Congress of the European-Society-of-Cardiology (ESC).","volume":"37","author":"Van Den Berg MJ","year":"2016","unstructured":"Van Den Berg, MJ, Bhatt, DL, Van Der Graaf, Y, Steg, PG, Visseren, FLJ; SMART Study Group and REACH Registry Investigators. Identifying patients with vascular disease at very high risk (VHR) for recurrent events according to the ACC\/AHA and ESC guideline criteria. Congress of the European-Society-of-Cardiology (ESC). 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