Risk Factor Modification in Stroke Prevention

Abstract

Background and Purpose-We reviewed Stroke Clinic data to determine the extent of risk factor modification achieved in patients with cerebrovascular disease over 2 years. Methods-Visits to the Stroke Clinic of a tertiary medical center from July 1, 1994, through June 30, 1996, were reviewed.Obesity, smoking, hypertension, hyperlipidemia, hyperglycemia, and lifestyle changes were noted in patients with Ն2 visits (nϭ61) and measures (number varied) of these parameters. Results-Fifty-six patients (92%) had primary care physicians. In the 49 patients with Ն2 weight measurements, 33 (67%)were moderately or severely overweight by weight-height correlation. Forty-four patients (90%) remained in the same weight category. Of the 60 patients with available blood pressure data, 50 (83%) were hypertensive. At their last visits, 43 of the 50 (86%) were receiving medications, and 22 of the 43 treated (51%) were controlled. Serum glucose remained elevated in 14 of 47 patients (30%) and in 11 of 16 diabetic patients (69%). Thirty-six of 47 patients (55%) had elevated lipid measurements. None of the 21 smokers quit during the study period. Few patients modified dietary and exercise practices. Of 61 patients, 29 (48%) sustained vascular events during the study, with 17 of these 29 patients (59%) having strokes or transient ischemic attacks. Conclusions-Although most patients were asked to quit smoking, received advice regarding diet and exercise, and were medicated for hypertension, elevated glucose, and cholesterol levels, their risk factor profiles showed little improvement during the 2-year period. More effective methods of controlling stroke risk factors are needed. (Stroke. 1999;30:16-20.)

Control of Hypertension 5 Years After Stroke in the North East Melbourne Stroke Incidence Study

“…The proportion with hypertension within these samples has been reported to be 60% at 3 months in a community stroke register, 4 56% at 1 year after discharge from a stroke unit, 15 74% in a 1-year follow-up of consecutive patients in a stroke prevention clinic, 5 and 82% within a consecutive sample from a Veteran's Affairs stroke clinic. 16 The greater proportion of people with hypertension in the present study may be attributable to the age difference between the NEMESIS cohort and those in the above-mentioned studies. The mean age of NEMESIS survivors was between 3 and 11 years older than the mean age within the other studies.…”

Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

“…13 This finding could be explained by both the reported decline in vascular risk in recent years, possibly related to improved vascular preventive measures, 16,17 and limited access to mortality data in our study.…”

“…13 However, the neurologists in the clinic relied on the primary-care physicians to prescribe therapy. In a large audit, in the UK, 14 41% of stroke patients achieved their BP target and 61% were still smoking.…”

Physical Activity and Exercise Recommendations for Stroke Survivors

“…89 In one recent study of stroke patients, data from a stroke clinic at a tertiary referral medical center in the United States indicated that during a 2-year period, 90% of patients who were overweight at their initial evaluation remained overweight, only 51% of hypertensive patients had their blood pressure under adequate control, serum lipids and lipoproteins remained abnormal in 55% of patients, none of the smokers quit smoking, and few patients modified their dietary or exercise practices. 90 Clearly, there is an urgent need to bridge the treatment gap by developing and implementing approaches that provide all stroke survivors with affordable access to effective, comprehensive stroke risk-reduction interventions. 91 …”