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April 16, 2008

Prognosis of Transient Neurological Attacks

JAMA. 2008;299(15):1771-1773. doi:10.1001/jama.299.15.1771-b

To the Editor: In their cohort study, Dr Bos and colleagues1 show Kaplan-Meier curves for the risk of ischemic heart disease and vascular death, as well as stroke, after transient neurological attacks (TNAs). These appear to indicate that the absolute event rates of these outcomes in this population equal or surpass the 20% 10-year risk of coronary events associated with coronary risk equivalents used in US guidelines to determine aggressiveness of use of statins and other therapies.2 There is evidence that patients with a history of ischemic stroke have a risk of coronary events equal to that of coronary risk equivalents,3,4 although patients with stroke are included as risk equivalents only in European (not US) guidelines.5