Therapeutic Interventions and Success in Risk Factor Control for Secondary Prevention of Stroke

• Published in: Journal of stroke and cerebrovascular diseases 2009-11, Vol.18 (6), p.460-465
• Main Authors: Alvarez-Sabin, Jose, MD, PhD, Quintana, Manuel, Hernandez-Presa, Miguel Angel, PhD, Alvarez, Carlos, MD, Chaves, Jose, PhD, Ribo, Marc, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Cardiovascular Agents - therapeutic use; Case-Control Studies; Coronary Artery Disease - drug therapy; Coronary Artery Disease - etiology; Coronary Artery Disease - prevention & control; Evidence-Based Medicine; Female; health policy and outcome research; Humans; Logistic Models; Male; medical; Middle Aged; Neurology; Odds Ratio; other stroke treatment; Practice Guidelines as Topic; Primary Health Care; Risk Assessment; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Spain; Stroke - drug therapy; Stroke - etiology; Stroke - prevention & control; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.014

Objective We sought to evaluate the success rates in achieving preventive therapeutic goals in patients who experienced an ischemic stroke (IS) and compare them with those achieved in patients with coronary artery disease (CAD). Methods This was an observational multicenter case-control study (3 patients with IS and one control subject with CAD) performed in 1444 primary health centers in Spain. Preventive therapeutic objectives according to American Heart Association guidelines were predefined. Demographic data, vascular risk factors, and success/failure in achievement of objectives were recorded and compared between patients with IS and CAD. Results A total of 5458 patients were included, 4098 (75.1%) had IS and 1360 (24.9%) had CAD. Although more than 90% of patients with hypertension, diabetes, or dyslipidemia were under specific drug regimens, only about 25% achieved the recommended therapeutic objective for each risk factor. Success rate was especially low among patients with IS compared with CAD: hypertension (23.8% v 27.2%; P = .028); dyslipidemia (13.6% v 20.3%; P < .001); and abdominal obesity (49.1% v 54.6%; P = .002). The only objective widely achieved in both groups was the use of antithrombotic drugs in atrial fibrillation (97.2% v 94.7%; P = .125). Only 3.3% of patients with IS had all risk factors under control, compared with 5.6% of those with CAD ( P = .006). For all patients, multivariate logistic regression model showed that independent predictors of full risk factor control were: presence of CAD as compared with IS (odds ratio [OR] 2.11; 95% confidence interval [CI] 1.35-3.29; P = .001), older age (OR 1.02; 95% CI 1.00-1.04; P = .028), and having less than 3 risk factors (OR 16.98; 95% CI 9.02-31.97; P < .001). Conclusions Success in achieving preventive therapeutic objectives for secondary prevention of vascular events is low, especially among patients with IS. There is an urgent need to devise strategies to improve risk factor control.