Stroke survivors who seem fully recovered are at a heightened risk of dying or experiencing a heart attack for at least five years after the event, research has shown.
A study of 26,366 patients found the long-term risks associated with having a stroke or mini-stroke, even one without complications, are more serious than was previously thought.
Compared with healthy individuals of the same age, the survivors were twice as likely to have died or suffered another stroke or heart attack within a year of their initial attack. The risks remained high for five years or more.
People who have had a stroke or fast-resolving transient ischaemic attack (TIA) - nicknamed a mini-stroke - are known to face a 90-day danger period, but this is thought mainly to apply to patients with complications.
Dr Richard Swartz, from Sunnybrook Health Sciences Centre in Toronto, Canada, who led the research, said: "There is a real need to maintain risk reduction strategies, medical support and healthy lifestyle choices over the long-term, even years after a mild initial event."
After five years, almost 36% of the patients in the study had died or experienced an adverse event such as another stroke, a heart attack or admission to long-term care, the research showed.
Writing in the Canadian Medical Association Journal, the scientists concluded: "These analyses indicate that survival after both stroke and TIA is a marker of long-term risk, which merits aggressive attention to risk reduction strategies.
"For survivors of stroke or TIA, the long-term risk of recurrent stroke was particularly high, indicating that stroke recurrence is the most important modifiable outcome."
The findings highlighted the need for long-term monitoring of blood pressure, irregular heart rhythms and lifestyle factors such as smoking and exercise, said Dr Swartz.
Commenting in the journal, Dr Michael Hill from the University of Calgary, wrote: "Stroke is under-recognised as a major public health problem and incorrectly considered to be a disease that affects only older people.
"In North America and Western Europe, stroke is the third or fourth leading cause of death overall, but in the developing world it is the first or second, depending on the country."
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