title: Trends in vascular risk factor treatment and control in US stroke survivors: the National Health and Nutrition Examination Surveys (1999-2010).
abstract: BACKGROUND
  Treatment and control of vascular risk factors reduce the likelihood of recurrent stroke. Present nationally representative data are sparse regarding secondary prevention treatment and control rates.
  
  
  RESULTS
  We evaluated sex- and race-stratified blood pressure, cholesterol, and hemoglobin A1c levels and treatment and control rates in 1154 self-reported stroke survivors from the National Health and Nutrition Examination Surveys 1999 to 2010. We used weighted linear regression to estimate time trends. Participants were 54% to 61% women, 70% to 76% white, and had a mean age of 63 to 66 years. For blood pressure, treatment rates remained unchanged in men, but in women, treatment rates increased from 41% in 1999 to 2000 to 65% in 2009 to 2010 (P=0.03), and control rates increased from 23% to 79% (P=0.03). Treatment rates remained unchanged in non-Hispanic whites, non-Hispanic blacks, and Mexican Americans, although control rates increased in non-Hispanic whites from 50% in 1999 to 2002 to 69% in 2007 to 2010 (P=0.04). For cholesterol, treatment rates increased from 30% to 40% in men (P=0.02) and from 28% to 36% (P<0.01) in women, but control rates increased only in men, from 62% to 87% (P<0.01). Cholesterol treatment rates increased only in non-Hispanic blacks, from 18% to 37% (P=0.02). By sex and race, there was no change in dysglycemia treatment and control.
  
  
  CONCLUSIONS
  Despite improvements in blood pressure treatment and control and cholesterol treatment for women and cholesterol treatment and control for men, stroke secondary prevention through treatment and control of vascular risk factors remains suboptimal. Urgent action is needed to improve secondary prevention to reduce stroke morbidity and mortality in this high-risk group.
authors: Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL 60611, USA.
authors: Nilay S
authors: NS
authors: Shah
authors: Mark D
authors: MD
authors: Huffman
authors: Hongyan
authors: H
authors: Ning
authors: Donald M
authors: DM
authors: Lloyd-Jones
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D009749:Nutrition Surveys; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000639:trends*; D012737:Sex Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; C517652:hemoglobin A1c protein, human
keywords: secondary prevention; stroke; treatment; trends
references: Circulation. 2007 Jan 2;115(1):127-55
references: 17179025
references: Stroke. 1995 Jan;26(1):30-3
references: 7839393
references: Stroke. 2000 Jul;31(7):1602-7
references: 10884460
references: Lancet Neurol. 2009 May;8(5):453-63
references: 19375663
references: BMJ. 1996 Jul 20;313(7050):147
references: 8688776
references: Lancet. 2001 Sep 29;358(9287):1033-41
references: 11589932
references: Eur J Cardiovasc Prev Rehabil. 2005 Dec;12(6):521-9
references: 16319540
references: Am Heart J. 2003 Dec;146(6):1045-51
references: 14660997
references: Diabetes Care. 2011 Jan;34 Suppl 1:S4-10
references: 21193627
references: Circulation. 2012 Jan 3;125(1):e2-e220
references: 22179539
references: Stroke. 2003 Nov;34(11):2741-8
references: 14576382
references: Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):212-9
references: 20233982
references: Am J Med. 2008 Jan;121(1):24-33
references: 18187070
references: JAMA. 2003 Jul 9;290(2):199-206
references: 12851274
references: N Engl J Med. 2006 Aug 10;355(6):549-59
references: 16899775
references: N Engl J Med. 2011 Dec 1;365(22):2088-97
references: 22080794
references: Am J Med. 2012 Sep;125(9):882-7.e1
references: 22748400
references: Lancet. 2004 Mar 6;363(9411):757-67
references: 15016485
references: J Stroke Cerebrovasc Dis. 2009 Nov-Dec;18(6):460-5
references: 19900649
references: Can J Neurol Sci. 2010 Mar;37(2):245-51
references: 20437937
references: BMJ. 2002 Jan 12;324(7329):71-86
references: 11786451
references: Eur J Neurol. 2009 Jun;16(6):678-83
references: 19236460
references: J Clin Hypertens (Greenwich). 2011 Sep;13(9):693-702
references: 21896153
references: Stroke. 1991 Feb;22(2):155-61
references: 2003278
references: Ann Thorac Surg. 2003 Mar;75(3):758-60
references: 12645689
references: Stroke. 2011 Jan;42(1):227-76
references: 20966421
references: Stroke. 2006 Jun;37(6):1497-502
references: 16627794
references: N Engl J Med. 2009 Jan 8;360(2):129-39
references: 19092145
references: Stroke. 2001 Aug;32(8):1884-9
references: 11486121
references: JAMA. 2011 Mar 2;305(9):913-22
references: 21364140
references: Lancet. 2011 Oct 1;378(9798):1231-43
references: 21872920
references: Stroke. 2003 Jun;34(6):1457-63
references: 12750544
references: Neurology. 1998 Jan;50(1):208-16
references: 9443482
references: N Engl J Med. 2008 Oct 9;359(15):1577-89
references: 18784090
references: Neurology. 2011 Sep 20;77(12):1182-90
references: 21900638
references: N Engl J Med. 2008 Jun 12;358(24):2560-72
references: 18539916
references: Stroke. 2007 Jun;38(6):1881-5
references: 17431209