title: Trends in risk factor prevalence and management before first stroke: data from the South London Stroke Register 1995-2011.
abstract: OBJECTIVE
  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. Antiplatelet prescription increased in atrial fibrillation (AF), myocardial infarction, and transient ischemic attack (AF, 37%-51%, P<0.001; myocardial infarction, 48%-69%, P<0.001; transient ischemic attack, 49%-61%, P=0.015). Anticoagulant prescription for AF showed a nonsignificant increase (12%-23%; P=0.059). Fewer older patients with AF were prescribed anticoagulants (age, >85 versus <65 years; adjusted relative risk, 0.19; 95% confidence interval, 0.08-0.41). Black ethnicity (adjusted relative risk, 1.17; 95% confidence interval, 1.10-1.23) and female sex (adjusted relative risk, 1.09; 95% confidence interval, 1.03-1.15) were associated with increased antihypertensive drug prescription; other medications did not vary by ethnicity or sex.
  
  
  CONCLUSIONS
  Antiplatelet and cholesterol-lowering treatment prescribing have improved significantly over time; however, only a minority with AF received anticoagulants, and this did not improve significantly. Overall, 30% of strokes occurred in patients with previously diagnosed but untreated risk factors.
authors: Division of Health and Social Care Research, King's College London, London, United Kingdom.
authors: Iain J
authors: IJ
authors: Marshall
authors: Yanzhong
authors: Y
authors: Wang
authors: Christopher
authors: C
authors: McKevitt
authors: Anthony G
authors: AG
authors: Rudd
authors: Charles D A
authors: CD
authors: Wolfe
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology; D011307:Drug Prescriptions / Q000592:standards; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
keywords: primary prevention; stroke; stroke epidemiology