Chagas disease: Independent risk factor for stroke

Background and Purpose-It has been suggested that Chagas disease (CD) and particularly CD cardiomyopathy are independent risk factors for cerebrovascular events. Strong evidence is scarce, cardioembolic and inflammatory mechanisms have been proposed, and most studies lack representative and well-matched controls. We sought to investigate CD, defined by positive serology, as an independent risk factor for stroke, by comparing patients admitted with ischemic stroke with representative control patients with a very similar cardiovascular risk factor profile. Methods-We performed a case-control study with 101 consecutive stroke patients and 100 consecutive acute coronary syndrome patients admitted to an emergency hospital. CD was investigated in all patients and was confirmed when both immunofluorescence and hemagglutination tests were positive. Clinical, laboratory, and ECG findings were analyzed. Results-We found that age (P=0.006), female sex (P=0.01), systolic blood pressure (P=0.001), diastolic blood pressure (P=0.03), previous stroke/transient ischemic attack history (P<0.001), atrial fibrillation (P=0.005), other arrhythmias (P=0.05), and CD-positive serology (P=0.002) were more frequent among stroke patients than among patients with acute coronary syndromes. After a multivariable analysis with a backward elimination procedure, previous stroke/transient ischemic attack history (odds ratio=6.98; 95% CI, 2.99 to 16.29), atrial fibrillation (odds ratio=4.52; 95% CI, 1.45 to 14.04), and CD-positive serology (odds ratio=7.17; 95% CI, 1.50 to 34.19) remained independently associated with stroke. CONCLUSIONS-: CD seems to be an independent risk factor for ischemic stroke. For patients in or coming from endemic regions, CD should be considered an etiologic or contributing factor for stroke.