In patients with ischemic stroke and transient ischemic attack (TIA) there is a significant gap between evidence-based cerebrovascular risk factors control and real-world stroke prevention, according to study results published in Neurology.

Whileprevious studies have found poor lifestyle and modifiable risk factors arecommon in patients with ischemic stroke, limited data are available on riskfactor control in patients with stroke/TIA.The goal of the study was to assess the prevalence of inadequatelytreated risk factors in a large cohort of patients with stroke/TIA.

The observational cohort study included patients from the Poststroke Disease Management STROKE-CARD trial (ClinicalTrials.gov Identifier: NCT02156778). Of 2625 adult patients with acute ischemic stroke or TIA admitted to the University Hospital Innsbruck, Austria, between January 2014 and December 2017, the study population comprised 1730 patients (median age 72 years, 59.6% men), including 1424 stroke patients and 306 patients with TIA. Of these, 1382 were first-ever strokes/TIAs.

Overall,79.5% of subjects had at least one inadequately treated stroke risk conditionbefore the index event. Hypercholesterolemia (53.4% of the study population)and hypertension (45.7%) were the most common risk factors, followed by atrialfibrillation (12.5%), previous atherosclerosis cardiovascular disease (12.4%),diabetes mellitus (9.9%), unrecognized TIA (2.7%), carotid stenosis (2.1%), andmechanical heart valves (0.5%).

Whenmodifiable lifestyle risk behaviors were included as inadequately-treated riskfactors, the percentage of subjects with at least 1 inadequately treated strokerisk condition before the index event was 95.1%. Many subjects had more than 1uncontrolled risk factor (eg, 72.3% had at least 2 inadequately treated riskfactors).

Thenumber of inadequately treated risk factors was higher in patients withrecurrent stroke/TIA, compared with patients with first-ever events (P <.001),in younger patients (75 years) compared with patients >75 years of age (P<.001), and in male patients (P =.003).

Assessmentof stroke preventability with adequate risk factors control revealed that bloodpressure control could have prevented 237 events (13.7%), while rigorous lipidprofile control could have prevented 182 events (10.5%) and properanticoagulation in patients with pre-diagnosed atrial fibrillation could haveprevented 145 events (8.4%). On theother hand, the estimated degree of stroke preventability with adequateanticoagulation in patients with mechanical heart valves was low (0.4%).

Forthe 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrialfibrillation, smoking, and overweight), the estimated degree of strokepreventability was 1 in 2, assuming an additive effect, and 1 in 4 with ahighly conservative computation approach.

Thestudy had several limitations, according to the researchers, including lack ofconsensus on the definition of adequate control of risk factors, missinginformation on pre-stroke blood pressure profiles, lack of valid way to assessthe quality of diet and physical activity.

Population-widecampaigns, individualized prevention and poststroke disease managementprograms, and an increased awareness among physicians about the concept ofstroke preventability are required to reduce the global burden of stroke,conclude the researchers.

Reference

Boehme C, Toell T, Mayer L, et al. The dimension of preventable stroke in a large representative patient cohort. [published online Oct 31, 2019]. Neurology. doi:10.1212/WNL.0000000000008573

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Risk Factors Are Frequently Inadequately Treated in Patients With Stroke or TIA - Neurology Advisor