Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
    • Without Borders
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
    • Without Borders
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

December 03, 2019; 93 (23) Article

The dimension of preventable stroke in a large representative patient cohort

Christian Boehme, Thomas Toell, Lukas Mayer, Lena Domig, Raimund Pechlaner, Karin Willeit, Lena Tschiderer, Lisa Seekircher, Peter Willeit, Andrea Griesmacher, Michael Knoflach, Johann Willeit, Stefan Kiechl
First published October 31, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008573
Christian Boehme
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thomas Toell
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lukas Mayer
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lena Domig
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Raimund Pechlaner
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karin Willeit
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lena Tschiderer
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lisa Seekircher
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter Willeit
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrea Griesmacher
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Knoflach
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Johann Willeit
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stefan Kiechl
From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Short Form
Citation
The dimension of preventable stroke in a large representative patient cohort
Christian Boehme, Thomas Toell, Lukas Mayer, Lena Domig, Raimund Pechlaner, Karin Willeit, Lena Tschiderer, Lisa Seekircher, Peter Willeit, Andrea Griesmacher, Michael Knoflach, Johann Willeit, Stefan Kiechl
Neurology Dec 2019, 93 (23) e2121-e2132; DOI: 10.1212/WNL.0000000000008573

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
52

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Objective To analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo.

Methods A total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect.

Results The proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%–81.4%) and increased to 95.1% (95% CI 94.1%–96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%–0.6%) to 13.7% (95% CI 12.2%–15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach.

Conclusions Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.

Glossary

ASCVD=
atherosclerotic cardiovascular disease;
AF=
atrial fibrillation;
BMI=
body mass index;
CI=
confidence interval;
mRS=
modified Rankin Scale

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 987

  • Received October 15, 2018.
  • Accepted in final form July 22, 2019.
  • © 2019 American Academy of Neurology
View Full Text

AAN Members: Sign in with your AAN member credentials (e-mail or 6-digit Member ID number)

Non-AAN Member subscribers: Sign in with subscriber credentials

Log in using your username and password

Forgot your user name or password?

Purchase access

AAN members must change their passwords on the AAN site

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Disputes & Debates: Rapid online correspondence

  • Reader response: The dimension of preventable stroke in a large representative patient cohort
    • Dearbhla M. Kelly, Clinical Research Fellow, Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford
    Published November 13, 2019
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Study funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Related Articles

  • Stroke preventionAn uphill battle

Topics Discussed

  • All Cerebrovascular disease/Stroke
  • Cohort studies
  • Stroke prevention

Alert Me

  • Alert me when this article is cited
  • Alert me if a correction is posted
  • Alert me when eletters are published
Neurology: 93 (23)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2019 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise