PT  - JOURNAL ARTICLE
AU  - Boehme, Christian
AU  - Toell, Thomas
AU  - Mayer-Suess, Lukas
AU  - Domig, Lena
AU  - Pechlaner, Raimund
AU  - Willeit, Karin
AU  - Tschiderer, Lena
AU  - Seekircher, Lisa
AU  - Willeit, Peter
AU  - Griesmacher, Andrea
AU  - Knoflach, Michael
AU  - Willeit, Johann
AU  - Kiechl, Stefan
TI  - The dimension of preventable stroke in a large representative patient cohort
AID  - 10.1212/WNL.0000000000008573
DP  - 2019 Dec 03
TA  - Neurology
PG  - e2121--e2132
VI  - 93
IP  - 23
4099  - http://n.neurology.org/content/93/23/e2121.short
4100  - http://n.neurology.org/content/93/23/e2121.full
SO  - Neurology2019 Dec 03; 93
AB  - 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.ASCVD=atherosclerotic cardiovascular disease; AF=atrial fibrillation; BMI=body mass index; CI=confidence interval; mRS=modified Rankin Scale