The dimension of preventable stroke in a large representative patient cohort.

Boehme, Christian; Toell, Thomas; Mayer, Lukas; Domig, Lena; Pechlaner, Raimund; Willeit, Karin; Tschiderer, Lena; Seekircher, Lisa; Willeit, Peter; Griesmacher, Andrea; Knoflach, Michael; Willeit, Johann; Kiechl, Stefan (2019). The dimension of preventable stroke in a large representative patient cohort. Neurology, 93(23), e2121-e2132. American Academy of Neurology 10.1212/WNL.0000000000008573

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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.

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5 Citations in Web of Science ®
6 Citations in Scopus

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