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Secondary prevention after ischemic stroke

Evolution over time in practice

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Abstract

Background and objective

An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time.

Method

We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid-lowering and anti-hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited.

Results

Prevention was not optimal in 96 of 123 (78%) patients in 1994, and in 77 of 125 (62 %) in 2002.Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and antihypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure >140/90mmHg, glycemia ≥ 126 mg/dl, total cholesterol level ≥ 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994.

Conclusion

Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8-year period.

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Authors and Affiliations

  1. Department of Neurology, Stroke Department, University of Lille Roger Salengro Hospital, 59037, Lille, France

    Marie Girot, Marie-Anne Mackowiak-Cordoliani, Dominique Deplanque, Hilde Hénon, Christian Lucas &  Didier Leys

  2. Department of Pharmacology, University of Lille Roger Salengro Hospital, 59037, Lille, France

    Dominique Deplanque

Authors
  1. Marie Girot
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  2. Marie-Anne Mackowiak-Cordoliani
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  3. Dominique Deplanque
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  4. Hilde Hénon
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  5. Christian Lucas
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  6. Didier Leys
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Corresponding author

Correspondence to Didier Leys.

Additional information

Research group on cognitive decline in degenerative and vascular disorders (EA 2691 from the Ministère de l’Education Nationale, de la Recherche et de la Technologie, MENRT).

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Girot, M., Mackowiak-Cordoliani, MA., Deplanque, D. et al. Secondary prevention after ischemic stroke. J Neurol 252, 14–20 (2005). https://doi.org/10.1007/s00415-005-0591-8

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  • DOI: https://doi.org/10.1007/s00415-005-0591-8

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