October 11, 2017
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Stroke risk factors increase despite drop in stroke mortality

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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.