Awareness, Treatment, and Control of Vascular Risk Factors among Stroke Survivors
Received 6 April 2009; received in revised form 16 June 2009; accepted 1 July 2009. published online 17 May 2010.
Introduction
Stroke survivors should recognize and control vascular risk factors to prevent recurrent strokes. We therefore assessed the prevalence, treatment, and control of hypertension, diabetes, and dyslipidemia among stroke survivors versus stroke-free control subjects.
Methods
We conducted cross-sectional analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study cohort, which includes oversampling from the Stroke Belt and African Americans. Patients were interviewed by telephone then visited for blood pressure, glucose, and lipid measurements. There were 2830 participants reporting a past stroke or transient ischemic attack (TIA) (stroke survivors) and 24,886 participants without past stroke or TIA (control subjects). Outcome measures included the recognition, treatment, and control of hypertension, diabetes, and dyslipidemia.
Results
Stroke survivors were more likely to have unrecognized hypertension (18.7% v 13.5%, P < .0003), unrecognized stage 2 hypertension (4.4% v 2.2%, P < .0006), and unrecognized diabetes (4.2% v 3.2%, P < .026) versus control subjects. Stroke survivors were more likely to be treated for hypertension (92.4% v 89.0%, P < .0001), diabetes (88.3% v 81.4%, P < .0001), and dyslipidemia (76.3% v 61.9%, P < .0001). However, despite treatment, stroke survivors were more likely to have hypertension (33.3% v 30.4%, P=.0074) and stage 2 hypertension (9.1% v 7.6%, P=.017). Predictors of unrecognized and undertreated risk factors in stroke survivors include increasing body mass index, black race, and lower education.
Conclusion
Despite having a past stroke or TIA, stroke survivors had higher rates of unrecognized hypertension, unrecognized diabetes, and undertreated hypertension. Better efforts are needed to help stroke survivors recognize and control vascular risk factors to prevent recurrent stroke.
∗Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Mobile, Alabama
†Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Mobile, Alabama
‡Department of Neurology, University of South Alabama, Birmingham, Mobile, Alabama
§Alabama Neurological Institute, Birmingham, Mobile, Alabama
//Department of Neurology, University of Cincinnati, Tucson
¶College of Public Health, The Ohio State University Columbus, Ohio, Tucson
#Department of Neurology, The University of Arizona, Tucson
Address correspondence to David A. Brenner, MD, Department of Neurology, Alabama Neurological Institute, 513 Brookwood Blvd, Suite 405, Birmingham, AL 35209.
Supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. This funding supports the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript.
There are no conflicts of interest or financial gain from any authors contributing to this manuscript. Dr. George Howard (study principal investigator) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr. George Howard performed the statistical analysis.
ABSTRACT