Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Abstract

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Indobufen versus aspirin in acute ischaemic stroke (INSURE): rationale and design of a multicentre randomised trial

“…Stroke is the second leading cause of death worldwide and the leading cause of mortality and disability in China 1 2. Patients with an acute ischaemic stroke have an approximately 5%–10% rate of another stroke within the first year of the initial event 3 4. Dual antiplatelet therapy with clopidogrel and aspirin has been shown to be more effective than aspirin alone for reducing new stroke for patients with minor ischaemic stroke or transient ischaemic attack,5–7 and was recommended as early management and secondary prevention strategy for these patients by the current guidelines 8 9.…”

SHR2285, the first selectively oral FXIa inhibitor in China: Safety, tolerability, pharmacokinetics and pharmacodynamics combined with aspirin, clopidogrel or ticagrelor

“…DAPT has been shown to reduce recurrent major ischemic events. However, there are still about 5.0-8.7% of cardiovascular death or ischemic events and 8.3% stroke recurrence rate 3,5 , indicating the involvement of hypercoagulability. In addition, DAPT significantly increases the risk of severe bleeding.…”

Trends and Risk Factors Associated With Stroke Recurrence in China, 2007-2018

“… 9 , 10 Despite improvements in evidence-based secondary prevention measures targeted at controlling traditional risk factors, patients with IS still appear to be at a residual risk of stroke recurrence. 11 , 12 , 13 This risk is likely associated with suboptimal control of traditional risk factors or lack of recognition and management of potential novel risk factors. 14 , 15 Nevertheless, few studies have investigated whether traditional risk factors, 16 , 17 , 18 , 19 , 20 including hypertension, diabetes, hyperlipidemia, and atrial fibrillation, are still associated with recurrence risk, and few studies have evaluated dynamic transitions of vascular risk factor patterns for stroke recurrence among the Chinese population.…”