Management of Vascular Risk Factors: An Undertreated Opportunity for Stroke Prevention
Purpose: To assess the quality of risk factor management before and after ischemic cerebrovascular disease. Methods: Records of 100 consecutive patients seen by the Stroke Service for TIA or stroke were reviewed. Control of modifiable risk factors including hypertension (HTN), hyperglycemia (DM), hypercholesterolemia (HCh), and obesity were recorded in the 3 months before the event (T-0), immediately after the event (T-1), and one year later (T-2). Not every risk factor was recorded in each time epoch for each patient. Results: History of HTN was present in 76, DM in 29, HCh in 33, and obesity in 45. At T-0, 33/71 had systolic blood pressure (SBP) >140, 23/64 had total cholesterol >200, 17/57 had LDL cholesterol >130, 10/22 had HbA1c >8 and 41/66 had body mass index (BMI) >25. At T-1, 72 patients had SBP ≥135. At T-2, only 19/72 controlled the SBP <140. Of the patients with known DM and a recorded HbA1c at T-1, 14/21 were ≥8. At T-2, 6/20 were ≥8. Of the 66 patients with no history of HCh, 16 had total cholesterol ≥200 and 8 had LDL ≥130 at T-0. Of those with known HCh, 11 had total cholesterol ≥200 and 9 had LDL ≥130 at T-0. At T-2, there were no data on LDL on 50 patients, while 30 had ≥100 and 9 were ≥130. Using body mass index (BMI) ≥25 as a marker for obesity, 45 of 62 patients were obese at T-1. At T-2, there were still 45/62 with a BMI ≥25. Conclusions: The majority of patients had at least one risk factor in poor control prior to the stroke or TIA. Our data indicate that risk factor management for primary prevention of stroke has considerable room for improvement. Following the stroke/TIA, management of DM, the area of our greatest risk management success, failed to achieve satisfactory control in 30% of patients at the end of 1 year. Treatment of obesity was our worst area, with no improvement from baseline. The 40% and 43% success rates for HCh and SBP are less than satisfactory. Our data indicate that stroke prevention may be enhanced with more aggressive management of known risk factors. While this study suffers from the problems inherent in small retrospective series, if validated by other studies, the implications are important.