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(Stroke. 2002;33:1656.)
© 2002 American Heart Association, Inc.

Original Contributions

How Well Are Hypertension, Hyperlipidemia, Diabetes, and Smoking Managed After a Stroke or Transient Ischemic Attack?

Mikael S. Mouradian, MD; Sumit R. Majumdar, MD, MPH, FRCPC; Ambikaipakan Senthilselvan, BSc, MSC, PhD; Khurshid Khan, MD Ashfaq Shuaib, MD, FRCPC

From the Division of Neurology (M.S.M., K.K., A. Shuaib) and Division of General Internal Medicine (S.R.M.), Department of Medicine, and Department of Public Health Sciences (A. Senthilselvan), University of Alberta, Edmonton, Alberta, Canada.

Correspondence to Ashfaq Shuaib, MD, FRCPC, Division of Neurology, Department of Medicine, University of Alberta, 2E3.13 Walter C. Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton Alberta T6G 2B7, Canada. E-mail ashfaq.shuaib{at}ualberta.ca

Background and Purpose— Stroke prevention clinics (SPCs) are not usually involved with the active management of hypertension, hyperlipidemia, diabetes, and smoking. The effect of consultations generated at SPCs on the adequacy of the management of these risk factors for stroke has not been well described, and few studies have long-term follow-up.

Methods— We performed a prospective study of 119 consecutive patients referred to an SPC for secondary prevention. One year after their baseline visit, patients were re-evaluated for the adequacy of the management of the above risk factors, and the proportion of improvement was assessed.

Results— One-hundred twelve patients returned for their 1-year follow-up visit. Sixty-six were male, and the average age was 65 years. Hypertension was present in 83 patients, hyperlipidemia in 92, diabetes in 26, and smoking in 38, and 80 had multiple risk factors. At baseline, 66% of patients with hypertension, 17% of patients with hyperlipidemia, and 23% of diabetics had adequate management of their respective risk factors. During 1 year of follow-up, hypertension management improved 20% (P<0.001) and lipid management improved 32% (P<0.001). There was no significant improvement in diabetes management or smoking cessation.

Conclusions— Although our understanding of the benefit of addressing hypertension, hyperlipidemia, diabetes, and smoking for secondary prevention of stroke is evolving, we found marked room for improvement in the management of these four risk factors. SPCs may need to be more actively involved in the management of these modifiable risk factors, if we are to significantly impact the risk of recurrent stroke.

Key Words: secondary prevention • stroke prevention

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