title: A comparison of secondary prevention practice in poststroke and coronary heart disease patients.
abstract: OBJECTIVE
  It is evident that patients with atherosclerotic vascular disease (AVD) benefit from appropriate secondary prevention. In clinical reality, the secondary prevention in AVD patients other than those with coronary heart disease (CHD) is often overlooked. Therefore, we compared the adherence to secondary prevention principles between poststroke and CHD patients.
  
  
  METHODS
  Descriptive (cross-sectional) study with prospective mortality follow-up.
  
  
  METHODS
  We examined 1729 chronic patients with AVD (mean age 65.9 (±SD 9.6) years), 964 with CHD, and 765 poststroke (pooled data of Czech samples of EUROASPIRE III, IV, and the ESH stroke survey). The interview was performed 6-36 months after the coronary event/revascularization or the first ischemic stroke, while the mortality follow-up 5 years after this interview.
  
  
  RESULTS
  Poststroke patients had a significantly higher risk of persistent smoking, blood pressure ≥140/90 mmHg and LDL ≥2.5 mmol/L than CHD patients [odds ratios adjusted for age, gender and survey were 1.63 (95% CI: 1.13-2.33), 1.38 (95% CI: 1.13-1.69) and 2.26 (95% CI: 1.84-2.78), respectively]. In contrast, poststroke patients showed a lower risk of inappropriate glucose control and hypertriglyceridemia [0.66 (95%CI: 0.54-0.82) and 0.74 (95%CI: 0.61-0.91), respectively]. The prescription rates of antiplatelets/anticoagulants, antihypertensives and statins were also significantly lower in poststroke than in CHD patients (89.4 vs 93.7, 85.9 vs 97.5, and 57.7 vs 89.8, respectively). Mortality analysis was performed in a subsample of 815 subjects interviewed in 2006/07. The 5-year all-cause mortality rates were 25.8% and 13.3% in poststroke and coronary patients, respectively (P = 0.0023); the hazard ratio for stroke adjusted for major risk factors was 1.85 (95% CI: 1.31-2.63).
  
  
  CONCLUSIONS
  Compared to CHD patients, poststroke patients are strongly handicapped in terms of poor adherence to secondary prevention target, prescription of basic pharmacotherapies and mortality risk.
authors.affiliation: 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Vaněk
authors.affiliation: 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic. Electronic address: mayero@fnplzen.cz.
authors.forename: O
authors.initials: O
authors.lastname: Mayer
authors.affiliation: 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Seidlerová
authors.affiliation: Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Bruthans
authors.affiliation: Department of Neurosurgery and Department of Neurology, University Hospital, Pilsen; Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Kielbergerová
authors.affiliation: Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Wohlfahrt
authors.affiliation: Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Krajčoviechová
authors.affiliation: 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Filipovský
authors.affiliation: Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; Department of Neurosurgery and Department of Neurology, University Hospital, Pilsen; Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Cífková
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003327:Coronary Disease / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003604:Czechoslovakia; D005260:Female; D006306:Health Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Coronary heart disease; ESH stroke survey; EUROASPIRE; Ischemic stroke; Secondary prevention