Secondary prevention after ischemic stroke. Evolution over time in practice.
OBJECTIVE
An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time.


METHODS
We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid-lowering and anti-hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited.


RESULTS
Prevention was not optimal in 96 of 123 (78%) patients in 1994, and in 77 of 125 (62 %) in 2002. Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and antihypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure >140/90 mmHg, glycemia >or = 126 mg/dl, total cholesterol level > or = 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994.


CONCLUSIONS
Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8-year period.
Girot
Marie
M
Department of Neurology, Stroke Department, University of Lille Roger Salengro Hospital, 59037 Lille, France.
Mackowiak-Cordoliani
Marie-Anne
MA
Deplanque
Dominique
D
Hénon
Hilde
H
Lucas
Christian
C
Leys
Didier
D
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy* / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000379:methods / Q000639:trends*; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control*; D013997:Time Factors
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors