In the JournalsPerspective

Stroke risk factors increase despite drop in stroke mortality

The prevalence of ischemic stroke risk factors such as diabetes, hypertension, dyslipidemia, smoking and drug abuse increased from 2004 to 2014, according to an analysis published in Neurology.

Risk factors increased despite a decline in stroke-related mortality in the U.S. during the past decade, according to the study.

“An estimated 80% of all first strokes are due to risk factors that can be changed, such as high blood pressure, and many efforts have been made to prevent, screen for and treat these risk factors. Yet, we saw a widespread increase in the number of stroke patients with one or more risk factors,” Fadar Oliver Otite, MD, ScM, from the department of neurology at University of Miami Miller School of Medicine, said in a press release. “These alarming findings support the call for further action to develop more effective methods to prevent and control these risk factors to reduce stroke risk.”

Researchers analyzed data from the 2004-2014 National Inpatient Sample of 922,451 hospitalizations for patients (47% men) admitted for acute ischemic stroke. Outcomes of interest included comorbid diabetes, hypertension, drug abuse and chronic renal failure.

Most patients (92.5%) had one or more risk factors. After adjusting for age and sex, 79.1% had hypertension, 46.9% had dyslipidemia as a secondary diagnosis, 34% had diabetes, 15.1% were smokers and 2.1% reported drug abuse. More than one quarter of patients (26.5%) also had secondary diagnoses of CAD, while 12.9% had carotid stenosis and 11.7% had chronic renal failure.

The prevalence of risk factors varied by age, particularly in hypertension, which was a secondary diagnosis in 44% of patients aged 18 to 39 years and 82% of patients aged 60 to 79 years. The rate of diabetes was higher in Hispanic patients (48.7%) vs. white patients (30.5%). Drug abuse was more prevalent in men (3%) compared with women (1.4%).

Joinpoint regression analysis showed annual increases in the prevalence of dyslipidemia (6.9%), drug abuse (6.7%), smoking (5.4%), diabetes (2.1%) and hypertension (1.4%). The prevalence of chronic renal failure (13%), carotid stenosis (5.9%) and CAD (0.9%) also increased annually. The number of patients with multiple risk factors increased during the study period.

“Increased awareness of these conditions, more frequent screening, improvement in detection systems and enhanced documentation are additional factors that may have led to increased prevalence, particularly for dyslipidemia, where prevalence estimates doubled over time,” Otite and colleagues wrote. – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

The prevalence of ischemic stroke risk factors such as diabetes, hypertension, dyslipidemia, smoking and drug abuse increased from 2004 to 2014, according to an analysis published in Neurology.

Risk factors increased despite a decline in stroke-related mortality in the U.S. during the past decade, according to the study.

“An estimated 80% of all first strokes are due to risk factors that can be changed, such as high blood pressure, and many efforts have been made to prevent, screen for and treat these risk factors. Yet, we saw a widespread increase in the number of stroke patients with one or more risk factors,” Fadar Oliver Otite, MD, ScM, from the department of neurology at University of Miami Miller School of Medicine, said in a press release. “These alarming findings support the call for further action to develop more effective methods to prevent and control these risk factors to reduce stroke risk.”

Researchers analyzed data from the 2004-2014 National Inpatient Sample of 922,451 hospitalizations for patients (47% men) admitted for acute ischemic stroke. Outcomes of interest included comorbid diabetes, hypertension, drug abuse and chronic renal failure.

Most patients (92.5%) had one or more risk factors. After adjusting for age and sex, 79.1% had hypertension, 46.9% had dyslipidemia as a secondary diagnosis, 34% had diabetes, 15.1% were smokers and 2.1% reported drug abuse. More than one quarter of patients (26.5%) also had secondary diagnoses of CAD, while 12.9% had carotid stenosis and 11.7% had chronic renal failure.

The prevalence of risk factors varied by age, particularly in hypertension, which was a secondary diagnosis in 44% of patients aged 18 to 39 years and 82% of patients aged 60 to 79 years. The rate of diabetes was higher in Hispanic patients (48.7%) vs. white patients (30.5%). Drug abuse was more prevalent in men (3%) compared with women (1.4%).

Joinpoint regression analysis showed annual increases in the prevalence of dyslipidemia (6.9%), drug abuse (6.7%), smoking (5.4%), diabetes (2.1%) and hypertension (1.4%). The prevalence of chronic renal failure (13%), carotid stenosis (5.9%) and CAD (0.9%) also increased annually. The number of patients with multiple risk factors increased during the study period.

“Increased awareness of these conditions, more frequent screening, improvement in detection systems and enhanced documentation are additional factors that may have led to increased prevalence, particularly for dyslipidemia, where prevalence estimates doubled over time,” Otite and colleagues wrote. – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    This nicely done study shows that the prevalence of CV risk factors and associated conditions are on the rise in acute ischemic stroke patients during a recent time period. One might predict that this would not be the case as there might a leveling off of the prevalence of CV risks or even a reduction in the prevalence of these factors and associated conditions based on current prevention efforts. However, this did not happen. The time period of the study, 2004 to 2014, is characterized by a proliferation of stroke centers throughout the U.S. and emphasis on coding for multiple diseases and risk factors to obtain maximum financial reimbursement. These factors may help to explain, at least in part, the increase in prevalence of the factors studied. 

    First and recurrent stroke risk is modifiable and control of a number of the factors studied in this paper could lead to reduction of recurrent stroke risk. Clinicians need to remain focused on CV risks in patients with acute ischemic stroke as the patients transition to the recurrent stroke prevention phase of care in that a number of the factors provide a fertile field for subsequent stroke prevention. The opportunity to control these factors should not be missed.

    The findings might be validated in other databases and controlled for temporal trends in possible changes in coding practices and proliferation of certified stroke centers. Further research could focus on lay and health care provider education about the importance of control of CV risks in persons with a history of stroke and CVD for recurrence reduction, and existent gaps in such medical care. 

    • Philip B. Gorelick, MD, MPH
    • Professor, Translational Science and Molecular Medicine
      Michigan State University College of Human Medicine
      Executive Medical Director, Mercy Health Hauenstein Neurosciences
      Grand Rapids, Michigan

    Disclosures: Gorelick reports no relevant financial disclosures.