How good is the management of vascular risk after stroke, transient ischaemic attack or carotid endarterectomy?
BACKGROUND
Patients remain at high risk of vascular events after stroke, transient ischaemic attack or carotid endarterectomy. We studied how well this risk is addressed by the effective treatment of modifiable risk factors.


METHODS
A total of 198 consecutive attenders at a rapid access stroke clinic and 98 consecutive patients undergoing carotid endarterectomy were studied. Treatment of hypertension and hyperlipidaemia, smoking status and the use of antithrombotic therapy were assessed at baseline and 6 months later. The findings were compared with targets from the UK National Clinical Guidelines for Stroke.


RESULTS
Baseline and follow-up data were available on 284 patients. The rates of control of vascular risk factors improved only slightly during follow-up. Blood pressure was below target levels in only 69 (24%) at baseline and 79 (28%) at 6 months, and serum cholesterol was below target levels in only 55 (19%) at baseline and 63 (22%) at 6 months. At baseline, 55 (19%) were smokers, of whom 12 (22%) had quit at 6 months. Anticoagulant therapy was prescribed in 19 of 37 patients (51%) in atrial fibrillation at 6 months. Antiplatelet therapy was prescribed in 90% of patients in sinus rhythm.


CONCLUSIONS
Despite the identification of vascular risk factors at the time of clinic or surgery, 6 months later these risk factors remain poorly addressed. More effective methods of managing vascular risk in these patients are needed.
Johnson
Paul
P
Department of Medicine for the Elderly, Royal Devon and Exeter Hospital, Exeter, UK.
Rosewell
Mary
M
James
Martin A
MA
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
D000925:Anticoagulants; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D002784:Cholesterol