Management of risk factors after ischemic stroke

Management of risk factors after ischemic stroke Background and aims. Adherence to preventive medication and to a healthy life style reduces stroke survivors’ risk of recurrent stroke. We investigated risk factor management in patients admitted to 3 Copenhagen hospitals with ischemic stroke (IS) Methods. Three hundred and twenty patients with acute IS were followed up 1 year after stroke. We constructed a baseline risk factor profile (RFP) of 6 variables: smoking, excessive drinking, physical inactivity, untreated hypertension, no cholesterol-lowering, and no antithrombotic treatment/warfarin at discharge from hospital. Each item was rated 0 or 1 giving a maximum score of 6 points. Mean baseline RFP-score was 1.6 Results. After 1 year we found a reduction in current smoking (p=0.008) and in excessive drinking (p=0.0001). There was no change in physical activity and in untreated hypertension. There was an increase in the proportion of patients on lipid-lowering (p=0.011) and antithrombotic (p=0.0003) treatment yielding a reduction in RFP to 1.4 (p<0.0001). Despite this improvement 194 (61%) of patients were hypertensive 1 year after stroke of whom 59 (30%) were untreated. Of 109 patients with hypercholesterolemia discharged without statins 87 (80%) remained untreated 1 year after stroke. By 1-year follow up 30 patients (9.4%) had had a non-fatal recurrent stroke or myocardial infarction Conclusions. We suggest the organisation of secondary prevention clinics within the stroke units for life style modification and treatment to target of risk factors immediately after discharge, thus extending the success of TIA clinics to all stroke survivors