Abstract Body: Introduction
Of all strokes, 25% are attributable to recurrent events, of which 80% can be prevented by adherence to secondary prevention guidelines. These involve managing and controlling risk factors for recurrence, such as blood pressure, body mass index (BMI), low-density lipoprotein (LDL) cholesterol, glycated hemoglobin (HbA1c), smoking, alcohol consumption and physical activity. We aimed to determine which proportion of stroke survivors adheres to standard AHA secondary prevention guidelines for risk factor management, the trends in adherence over time, and whether guideline adherence is associated with a lower risk of mortality.
Methods
We collected cross-sectional data on stroke survivors using the National Health and Nutrition Examination Survey (NHANES) from 1999-2018 linked to death certificate records up to December 2019. We collected data on demographics and determined adherence using secondary stroke prevention guidelines per risk factor. We compared proportion of participants that adhere to guidelines to an age, sex and race matched control population, examined trends over time using a generalized linear model and used cox proportional hazards models to determine the effect of adherence to individual risk factor guidelines on post-stroke mortality. All analyses were performed using the survey weights provided by the NHANES designed to make the population representative of US demographics.
Results
We included 2,197 stroke survivors, of whom 51% were female with a mean age of 68. For the AHA secondary prevention guidelines, stroke survivors were less likely than controls to adhere to blood pressure, BMI, smoking and physical activity guidelines, but more likely to adhere to LDL guidelines. In stroke survivors, adherence to blood pressure (+1.4% per 2-year increment) and LDL (+3.0%) guidelines improved over time, while adherence to physical activity guidelines (-1.1%) declined. Adherence to guidelines on blood pressure (HR 0.55 [95% CI 0.41-0.64]), smoking (HR 0.55 [95% CI 0.44-0.69]) and physical activity (HR 0.51 [95% CI 0.41-0.64]) was associated with a reduced risk of mortality during a median follow-up of 70 months.
Conclusion
Many stroke survivors are unable to meet standard secondary prevention guidelines, but adherence to blood pressure and LDL guidelines is improving. Adherence to secondary prevention guidelines is associated with lower mortality among stroke survivors.