Abstract 2945: Missed Opportunities for Primary Stroke Prevention among Young Adults in the United States.
The incidence of stroke is increasing in young adults. However, little is known about primary prevention in this population. Prevention of stroke among young and early middle-aged adults is particularly important as they face with years of disability after a stroke. Our objective was to define the prevalence of modifiable stroke risk factors and steps taken to address them among the younger adults during outpatient clinic visits within the United States.
Methods: Data from the 2008 and 2009 National Ambulatory Medical Care Survey dataset were analyzed. Young subjects (18 to 45 years) visiting medical specialties were selected. Weighted frequencies of diabetes, hypertension, tobacco abuse, hyperlipidemia, and obesity were estimated based on physician reported data about these conditions. Proportions of subjects receiving education about weight reduction, exercise, diet and nutrition, smoking cessation and prescriptions were estimated.
Results: There were an estimated 324.7 million medical office visits in 2008 and 2009. The majority of these visits were to Internal Medicine (20.5%) and Family medicine (45.8%) practices, whereas (2.5%) visits were to neurologists. Smoking (20.6%) was the most prevalent risk factor recognized by physicians, followed by obesity (16.7%), hypertension (12.3%), hyperlipidemia (7.7%) and diabetes (6.6%). Only 19.5% of all smokers were documented to have received smoking cessation advice. Weight reduction counseling was provided to 15.8% of obese patients, 14.9% of hypertensive, 16.2% of diabetic and 13.9% of hyperlipidemic subjects. Diet and nutrition counseling was provided to 23.4% of obese, 24.9% of hypertensive, 30.1% of diabetics and 29.9% of hyperlipidemic subjects. Exercise was advised to 19.5% of obese, 17.6% of hypertensive, 20.6% of diabetics and 24.1% of hyperlipidemic subjects. Statins were prescribed to 91.1% of subjects with hyperlipidemia, 89.9% of diabetics were on insulin and 10.7% were on oral drugs, whereas only 13.6% of hypertensive subjects were on prescription medication.
Conclusion: A substantial proportion of young adults are found to have modifiable stroke risk factors during office visits. There is a high use of prescriptions to treat hyperlipidemia and diabetes, however counseling regarding lifestyle changes is dismal. Efforts should be made fulfill the potential of the medical practioners in providing effective stroke prevention in young adults. Further research should concentrate on the systems of structured management of stroke prevention in primary care practice.
- © 2012 by American Heart Association, Inc.