title: How well are hypertension, hyperlipidemia, diabetes, and smoking managed after a stroke or transient ischemic attack?
abstract: OBJECTIVE
  Stroke prevention clinics (SPCs) are not usually involved with the active management of hypertension, hyperlipidemia, diabetes, and smoking. The effect of consultations generated at SPCs on the adequacy of the management of these risk factors for stroke has not been well described, and few studies have long-term follow-up.
  
  
  METHODS
  We performed a prospective study of 119 consecutive patients referred to an SPC for secondary prevention. One year after their baseline visit, patients were re-evaluated for the adequacy of the management of the above risk factors, and the proportion of improvement was assessed.
  
  
  RESULTS
  One-hundred twelve patients returned for their 1-year follow-up visit. Sixty-six were male, and the average age was 65 years. Hypertension was present in 83 patients, hyperlipidemia in 92, diabetes in 26, and smoking in 38, and 80 had multiple risk factors. At baseline, 66% of patients with hypertension, 17% of patients with hyperlipidemia, and 23% of diabetics had adequate management of their respective risk factors. During 1 year of follow-up, hypertension management improved 20% (P<0.001) and lipid management improved 32% (P<0.001). There was no significant improvement in diabetes management or smoking cessation.
  
  
  CONCLUSIONS
  Although our understanding of the benefit of addressing hypertension, hyperlipidemia, diabetes, and smoking for secondary prevention of stroke is evolving, we found marked room for improvement in the management of these four risk factors. SPCs may need to be more actively involved in the management of these modifiable risk factors, if we are to significantly impact the risk of recurrent stroke.
authors.affiliation: Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mikael S
authors.initials: MS
authors.lastname: Mouradian
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.forename: Khurshid
authors.initials: K
authors.lastname: Khan
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000628:therapy*; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome