The incidence of Stroke in Chiropractic is 0.01% - Equivalent to a Family Doctor Visit

The incidence of Stroke in Chiropractic is 0.01% - Equivalent to a Family Doctor Visit

Complied by Dr. Ayhem Sabry B.S., D.C.

Key Research Findings:

1. Cassidy et al. (2008) conducted a large population-based case-control study published in Spine that analyzed the risk of vertebrobasilar artery (VBA) stroke associated with chiropractic care versus primary care physician (PCP) visits.
2. 
   
   • The study found no increased risk of stroke after visiting a chiropractor compared to visiting a family medicine physician.
   • The authors concluded that patients seeking care for neck pain or headaches (early symptoms of arterial dissection) were already at risk of stroke, regardless of whether they saw a chiropractor or a medical doctor.
   • Key finding: Patients had the same likelihood of experiencing a stroke within days of visiting either a chiropractor or a primary care doctor.
3. Rothwell et al. (2001) published in Stroke examined cases of vertebral artery dissection (VAD)-related strokes and their association with chiropractic manipulation.
4. 
   
   • They found that strokes occurred in young patients who had visited either a chiropractor or a medical doctor for neck pain and headaches, suggesting that these symptoms were likely early warning signs of an impending stroke rather than caused by the clinical visit itself.

Why is the Risk Similar?

• Pre-Stroke Symptoms: Many strokes, particularly vertebral artery dissections, present with neck pain and headaches before the stroke occurs.
• Patient Behavior: Patients experiencing these early stroke symptoms may seek care from either a chiropractor or a family doctor, making it appear as though the provider visit is associated with the stroke.
• Timeframe of Stroke Onset: The stroke may develop after a healthcare visit simply because the patient was already in the process of experiencing arterial dissection.

Conclusion:

• A patient experiencing a stroke after visiting a chiropractor is statistically just as likely to have experienced a stroke after visiting a family physician.
• Chiropractic adjustments have not been shown to increase the risk of stroke compared to primary care visits.
• The underlying cause is the patient's pre-existing vascular condition, not the clinical visit itself.

References

1.  Hypertension:
O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-775. doi:10.1016/S0140-6736(16)30506-2.

2. Atrial Fibrillation:
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-988. doi:10.1161/01.STR.22.8.983.

3.  Diabetes:
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2014;45(7):2160-2236. doi:10.1161/STR.0000000000000024.

4.  Smoking:
Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989;298(6676):789-794. doi:10.1136/bmj.298.6676.789.

5.  High Cholesterol:
Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-559. doi:10.1056/NEJMoa061894.

6. Physical Inactivity and Obesity:
Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34(10):2475-2481. doi:10.1161/01.STR.0000087175.49165.35.

7.  Chiropractic Doctor Visit & Family Doctor Visit Stroke Incidence:
Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976). 2008;33(4 Suppl):S176-S183. doi:10.1097/BRS.0b013e3181644600.