Trends in Risk Factor Prevalence and Management Before First Stroke

Abstract

Stroke remains a major preventable cause of morbidity and mortality internationally.1 In addition to lifestyle modification, cost-effective drug treatments for hypertension, hypercholesterolemia, and atrial fibrillation (AF) reduce stroke risk, heart disease, and mortality. [2][3][4] Despite international guidance aimed at improving primary prevention, risk factor control rates remain low. [5][6][7] Suboptimal control is associated with inadequate risk factor detection and treatment, ethnic differences in risk factor susceptibility and response to treatment, socioeconomic deprivation, and poor treatment adherence. 5,[7][8][9] Several studies have found ethnic differences in stroke risk factors. A US case-control study found that hypertension and diabetes mellitus were significantly more prevalent among black than white patients with stroke, whereas AF was significantly more prevalent in white patients.10 Similar results were reported by the South London Stroke Register (SLSR) from 1995 to 1998. 11 A US cross-sectional study found that apparent ethnic differences in stroke risk factors were explained by differences in income. 12 We sought to examine trends from 1995 to 2011 in beforestroke risk factors and use of appropriate treatment, using data from the SLSR. We aimed to investigate variation in risk factors by age, sex, ethnicity, socioeconomic group, and stroke subtype, and factors associated with appropriate treatment. MethodsThe methods of the SLSR have been described previously 13 and are summarized below. The SLSR is a population-based register recording all first strokes in a defined region of Lambeth and Southwark, with a population of 310 028 according to the 2001 UK Census, with 63% white, 28% black (9% black Caribbean, 15% black African, and 4% black other), and 9% other ethnic group. By 2011, the source population had increased to 357 308, with 56% white, 25% black (7% black Caribbean, 14% black African, 4% black other), and 18% other.Background and Purpose-Vascular risk factors are suboptimally managed internationally. This study investigated time trends in risk factors diagnosed before stroke and their treatment, and factors associated with appropriate medication use. Methods-A total of 4416 patients with a first stroke were registered in the population-based South London Stroke Register from 1995 to 2011. Previously diagnosed risk factors and usual medications were collected from patients' primary care and hospital records. Trends and associations were assessed using multivariate logistic regression. Results-Seventy-two percent of patients were diagnosed previously with 1 or more risk factors; 30% had diagnosed risk factors that were untreated. Hypercholesterolemia increased significantly during the study period; myocardial infarction and transient ischemic attack prevalences decreased. [TIA], and diabetes mellitus) and usual prescribed medication (antiplatelets, anticoagulants, antihypertensive drugs, and cholesterol-lowering drugs) were collected from patients' general practitioners and hospit...

The effects of socioeconomic status on stroke risk and outcomes

“…79 Additionally, a 2013 analysis of the South London Stroke Register found no differences in risk factor profiles prior to stroke or primary prevention use for different socio-economic groups. 80 The possibility remains, however, that idiosyncrasies in the SES measures used, or the particular populations studied in these papers might equally explain the differences.…”

Age and Ethnic Disparities in Incidence of Stroke Over Time

“…A recent study by Marshall et al 31 showed antiplatelet and cholesterol-lowering treatment for treating beforestroke risk factors had improved significantly from 1995 to 2010 in SLSR, similarly for both white and black patients. We do not have information on the use of these medications among different age groups.…”

Improving anticoagulation in atrial fibrillation: observational study in three primary care trusts

“…[13][14][15] Fewer older patients with AF are prescribed anticoagulants, and anticoagulant use is poorly related to stroke risk. 2,16 The slope of improvement in anticoagulant use has been static for more than 10 years, improving by 1% per annum to only 50% in 2012. 14,17,18 Undertreatment at older ages persists in more recent studies.…”