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April 16, 2008

Prognosis of Transient Neurological Attacks—Reply

JAMA. 2008;299(15):1771-1773. doi:10.1001/jama.299.15.1772

In Reply: Dr Elkind raises the interesting question of whether the excess risk of vascular disease among TNA patients raises their absolute 10-year risk over 20%, which according to current guidelines would warrant aggressive lipid control and other vascular risk reduction therapies.1 These guidelines are based on persons aged 20 to 75 years2 and are hard to extrapolate to an older population such as the one we studied because in elderly persons the 10-year risk of stroke and ischemic heart disease is exceedingly high. Moreover, it is common practice to base treatment recommendations on risk factor profiles, taking into account age, sex, and other cardiovascular risk factors. Our data lack power for such a detailed analysis of the prognosis of TNA patients. We therefore can only report the mean absolute risk, which is hard if not impossible to extrapolate from one community to another.3