Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

Cheng, Eric M.; Chen, Alex; Vassar, Stefanie D.; Lee, Martin; Cohen, Stanley N.; Vickrey, Barbara G.

doi:10.1159/000091220

Cited by 12 publications

(8 citation statements)

References 46 publications

(33 reference statements)

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“…The effects of training as they pertain to secondary stroke prevention, death, dependence and disability after stroke remain unclear [116]. Although secondary prevention programs for stroke patients exist, they are not as well studied or widely available as secondary prevention programs for cardiac patients [117]. …”

Section: Physical Exercise In Primary Prevention Of Cvdmentioning

confidence: 99%

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Schmidt¹,

Endres²,

Dimeo

et al. 2013

Cerebrovasc Dis

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The burden of cerebrovascular disease (CVD) is huge and therapeutic options are limited. Physical activity is effective in preventing coronary heart and peripheral artery disease both experimentally and clinically. It is likely that the protective effects of exercise can be extended to both CVD and cognitive impairment. The pleiotropic protective and preventive mechanisms induced by physical activity include increased perfusion as well as mechanisms of collateral recruitment and neovascularization mediated by arterio- and angiogenesis. Physical activity increases the bioavailability of nitric oxide, bone marrow-derived CD34+ cells and growth factors, all of which promote neovascularization. Additionally, shear stress is discussed as a potential mechanism for vessel growth. Moreover, physical activity plays a role in endothelial function and cerebral autoregulation in small- and large-artery CVD. The vascular niche hypothesis highlights the complex interactions of neuro- and angiogenesis for regenerative and repair mechanisms in the human brain. Experimental and clinical studies demonstrate the positive impact of prior physical activity on stroke lesion size and on outcome after stroke. Clinical trials are necessary to further address the impact of physical activity on primary and secondary stroke prevention, outcome and cognitive function.

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Section: Physical Exercise In Primary Prevention Of Cvdmentioning

confidence: 99%

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Schmidt¹,

Endres²,

Dimeo

et al. 2013

Cerebrovasc Dis

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“…Half of the hypertensives were untreated or even undetected, and only 11.5% had achieved the recommended treatment goal, which was lower than the rate reported in the USA (38%) [8, 22]. …”

Section: Discussionmentioning

confidence: 79%

Long-Term Stroke Prognosis in Relation to Medical Prevention and Lifestyle Factors

Engström²,

Janzon³

et al. 2008

Cerebrovasc Dis

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Background: Few studies have focused on the quality of secondary prevention among long-term stroke survivors. This study explores the intensity of medical intervention and the impact of lifestyle and other risk factors on the long-term stroke prognosis in a population-based setting of Swedish individuals with a history of stroke. Methods: A population-based cohort (n = 28,449) in Malmö, Sweden, was recruited during 1991–1996. Of them, 394 had a history of stroke, according to self-reported physician diagnosis and record linkage with the Stroke Register in Malmö. Information on medical intervention and lifestyle factors was collected from the questionnaire. The incidence of a cardiac event (CE) or recurrent stroke was followed for 7.5 years after the baseline examination. Results: The prevalence of hypertension was 79.4% in patients with a history of stroke. Only half of them received blood-pressure (BP)-lowering medication, and 11.5% of them achieved a BP <140/90 mm Hg. Most patients with hypercholesterolemia did not receive lipid-lowering medication. Antithrombotic agents were used by 38%. Nearly one third were still smoking, and two thirds were overweight or obese. Compared to subjects without a history of stroke, the risk of cardiovascular disease (CVD, i.e. CE or recurrent stroke) was significantly higher in stroke survivors. The increased CVD risk was significantly associated with elevated BP levels. No significant relationship was found between CVD risk and lifestyle risk factors reported at the time of baseline examination. Conclusions: There was a large gap between recommended secondary preventive measures and their implementation in subjects with a history of stroke. Achieving recommended hypertension control may prevent a substantial proportion of the CE and recurrent strokes in this group.

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“…We hypothesized that patients undergoing cardiac procedures (CABG or PCI) would have better BP and LDL control compared with patients undergoing CEA because of greater availability of specialty programs and cardiologists among persons with a cardiac event. 6 …”

mentioning

confidence: 99%

Suboptimal Control of Atherosclerotic Disease Risk Factors After Cardiac and Cerebrovascular Procedures

Cheng

Asch

Brook

et al. 2007

Stroke

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Background and Purpose-Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein. Methods-Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (nϭ252), coronary artery bypass graft (nϭ486), or percutaneous coronary intervention (nϭ720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using 2 tests and multivariate logistic regression. Results-The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure (Pϭ0.05) compared with increases from 32% to 43% for coronary artery bypass graft (Pϭ0.001) and from 29% to 45% for percutaneous coronary intervention (Pϭ0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure (OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein (OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure (OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control. Conclusions-Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients. (Stroke. 2007;38:929-934.)

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Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

Cited by 12 publications

References 46 publications

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Long-Term Stroke Prognosis in Relation to Medical Prevention and Lifestyle Factors

Suboptimal Control of Atherosclerotic Disease Risk Factors After Cardiac and Cerebrovascular Procedures

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