Takeaway
- Roughly 25%-50% of strokes could have been prevented by adequately controlling the most relevant medical conditions and lifestyle behaviours as recommended in guidelines.
Why this matters
- Opportunity for intervention to reduce strokes and related morbidity and mortality.
Key results
- Patients with ≥1 inadequately treated risk:
- 79.5% considering only drug-amenable conditions.
- 95.1% considering drug-amenable conditions plus lifestyle risk behaviours.
- Groups with poorer risk factor control:
- Patients with recurrent vs first-ever stroke (P<.001).
- Men vs women (P=.003).
- Patients ≤75 vs >75 years of age (P<.001).
- 0.4%-13.7% of strokes preventable by individual risk factor.
- With adequate control of 5 most relevant risk factors combined (hypertension, hypercholesterolaemia, Afib, smoking, overweight), strokes prevented:
- About 1 in 2 with standard estimation.
- About 1 in 4 with highly conservative estimation.
Expert comment
- In an editorial, Laurel A. Beckett, PhD, and Lars F. Berglund, MD, PhD, write, “….we appear to have much farther to climb on the steep slope toward reduction of strokes. On the other hand, the article also offers hope that a more systematic effort to meet available guidelines might lead to dramatic improvements.”
Study design
- Austrian observational cohort study of 1730 patients experiencing acute ischaemic stroke or transient ischaemic attack (Poststroke Disease Management STROKE-CARD trial).
- Pre-event risk factors assessed:
- 8 conditions amenable to medical therapy.
- 3 lifestyle behaviours.
- Main outcome: stroke risk.
- Funding: Tyrolean government; Boehringer Ingelheim; others.
Limitations
- Conditions, behaviours assessed somewhat arbitrarily.
- Approach to defining control for certain risk factors.
- Uncertain generalisability.
References
References
