Abstract T MP98: Guideline-directed LDL Management Prior to Onset of Acute Ischemic Stroke in Patients with and Without Pre-existing Cardiovascular Disease: Findings from GWTG-stroke
Context: Limited information is available whether high risk patients had achieved guideline-directed LDL goals prior to presenting with an acute ischemic stroke.
Objective: To evaluate differences in the attainment of current LDL guidelines, based on admission LDL testing, in patients with acute ischemic stroke.
Methods: Observational study, using data from the AHA-Get With The Guidelines Registry including 913,436 patients with an acute ischemic stroke or transient ischemic attack from April 2003 to September 2012. Participants were classified as high risk if they had prior history of TIA, stroke, and/or coronary artery disease (CAD). We used a previously created algorithm to determine the pre-stroke NCEP ATP-III goal.
Results: Of the 913,436 patients admitted with an acute stroke or TIA, 283,162 (31.0%) had prior stroke/TIA, and 148,833 (16.3%) had prior CAD. Overall, only 68% of stroke patients were at their pre-admission NCEP III guideline-recommended LDL target on admission testing; 51.3% had LDL <100 mg/dL and only 19.8% had LDL100 mg/dL. Compared to patients with CAD, patients with prior TIA/Stroke were less likely to have LDL <100 mg/dL or <70 mg/dL (Table 1). In multivariable analysis, older age, male, white race, lack of major vascular risk factors, prior use of cholesterol-lowering therapy, and care provided in larger hospitals or West/Midwest hospitals were associated with meeting NCEP III LDL targets on admission testing.
Conclusion: Current management of dyslipidemia in high risk patients with pre-existent CAD or stroke continues to be suboptimal. Only one in four patients with prior TIA/Stroke have LDL levels at the strict target <70 mg/dL.
Author Disclosures: G. Saposnik: None. G.C. Fonarrow: None. W. Pan: None. A.F. Hernandez: None. L. Schwamm: Consultant/Advisory Board; Modest; Joint Commission; MA Dept of Public Health. Other; Modest; AHA Get With the Guidelines (unpaid); Coverdell Registry Advisor (unpaid); MGH provides telehealth services under contract to hospitals in northern new england. Employment; Significant; Director, MassGeneral TeleHealth. E.E. Smith: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.