RT Journal Article
SR Electronic
T1 The dimension of preventable stroke in a large representative patient cohort
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2121
OP e2132
DO 10.1212/WNL.0000000000008573
VO 93
IS 23
A1 Boehme, Christian
A1 Toell, Thomas
A1 Mayer-Suess, Lukas
A1 Domig, Lena
A1 Pechlaner, Raimund
A1 Willeit, Karin
A1 Tschiderer, Lena
A1 Seekircher, Lisa
A1 Willeit, Peter
A1 Griesmacher, Andrea
A1 Knoflach, Michael
A1 Willeit, Johann
A1 Kiechl, Stefan
YR 2019
UL http://n.neurology.org/content/93/23/e2121.abstract
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