Abstract TMP99: Farmalarm: App for Mobile Devices Improves Risk Factor Control After Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marc Ribo ◽  
Estefania montiel ◽  
Estela Sanjuan ◽  
Mireia Sanchis ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Medical Staff ◽  
Healthy Lifestyle ◽  
Medication Compliance ◽  
Treatment Compliance ◽  
Lifestyle Changes ◽  
Stroke Patients ◽  
Risk Factor Control ◽  
Stroke Awareness

Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance Methods: Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients Results: During 16 months, from the 457 patients discharged home, 126 (27.6%) were included in the study: Farmalarm n=74; age 57±12, Control n=52, age 59±10. There were no significant differences in baseline characteristics between groups. Patients in Farmalarm group followed the program for 23±6 days after discharge. In Farmalarm group, mean number alarms due to medication intake failure dropped from 68.5% in the first week to 44.6% in the third week (p=0.03). At 90 days, achievement of risk factor control was higher in the FARMALARM group (table). The rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (45.3% Vs 22.5%; p=0.02) (graph) and less patients dropped all medications at 3 months in the Farmalarm group (1.5% Vs 8.16%:p=0.05). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 4.7; 95% CI:1.1-6.9;p=0.03). Conclusion: In stroke patients discharged home the use of mobile applications to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors.

Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Wienbergen ◽  
A Fach ◽  
S Meyer ◽  
J Schmucker ◽  
R Osteresch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Prevention Program ◽  
Study Endpoint ◽  
Funding Source ◽  
Risk Factor Control ◽  
One Year

Abstract Background The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after >24 months (“prevention boost”) is effective. Methods In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control. In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention. Results At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p<0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p<0.05, Figure 1). A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p<0.05 between the groups, Figure 1). Conclusions IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after >24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)

Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Malik ◽  
H Chen ◽  
A Cooper ◽  
M Gomes ◽  
V Hejjaji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Optimal Control ◽  
Risk Factor ◽  
Socioeconomic Factors ◽  
Funding Source ◽  
Risk Factor Control ◽  
Cv Disease

Abstract Background In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease. Purpose To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D. Methods DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c <7%, BP <140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control. Results Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c <7%. Conclusions In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country. Proportion of patients at goal Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca

scholarly journals Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Xu ◽  
Xiaoyu Zhang ◽  
Huan Chen ◽  
Zhangning Zhao ◽  
Meijia Zhu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Factor Score ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Risk Factor Score ◽  
Stroke In Young

Abstract Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Abstract 121: Vascular Risk Factor Control in the Year After Ischemic Stroke Versus Myocardial Infarction

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Dawn M Bravata ◽  
Jared Brosch ◽  
Jason Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Standard Deviation ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Hypertension Control ◽  
Stroke Patients ◽  
Risk Factor Control ◽  
Facility Level

Background: The Veterans Health Administration has multiple quality improvement activities directed at improving vascular risk factor control. We sought to examine facility quality of blood pressure (BP) control (<140/90 mm Hg), lipid control (LDL-cholesterol <100 mg/dL) and glycemic control (HbA1c <9%) in the one-year after hospitalization for ischemic stroke or acute myocardial infarction (AMI). Methods: We assembled a retrospective cohort of patients hospitalized with stroke or AMI (fiscal year 2011). Facilities were included if they admitted ≥25 stroke patients and ≥25 AMI patients. A facility-level consolidated measure of vascular risk factor control was calculated for the 3 processes of care (number of passes divided by number of opportunities). Results: A total of 2432 patients had a new stroke and 4873 had a new primary AMI (at 75 facilities). Stroke patients had worse vascular risk factor control than AMI patients (mean facility rate on consolidated measure: stroke, 70% [95%CI 0.68-0.72] vs AMI, 77% [0.75-0.78]). The greatest disparity between stroke and AMI patients was in hypertension control: at 87% of hospitals, fewer stroke patients achieved BP control than AMI patients (mean facility pass rate: stroke, 41% vs AMI, 52%; p<0.0001). Overall there were no statistical differences for stroke versus AMI patients in facility-level hyperlipidemia control (71% vs 73%, p=0.33) and glycemic control (79% versus 82%, p=0.24). AMI patients had more outpatient visits than stroke patients in the year after discharge [AMI: mean 7.9 visits (standard deviation 6.1)]; stroke: mean 6.0 visits (standard deviation 4.5; p<0.0001].); the primary difference in outpatient utilization was additional cardiology visits for AMI patients (2.5 visits with cardiology per AMI patient vs 0.4 visits per stroke patient; p<0.001). Conclusions: These results demonstrated clinically substantial disparities in hypertension control among patients with stroke vs patients with AMI. It may be that cardiologists provided risk factor management to AMI patients that stroke patients did not receive. The etiology of these observed differences merits additional investigation.

Abstract 1122‐000035: Is Age Critical in Determining Stroke Severity Within the Telestroke Network?

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Cassie A Simmons ◽  
Nicolas Poupore ◽  
Fernando Gonzalez ◽  
Thomas I Nathaniel
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Risk Factor ◽  
Univariate Analysis ◽  
Baseline Risk ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Patients Âgés ◽  
Increased Risk

Introduction : Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people >65 years of age. In addition, adults >75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages >65 and <75 as well as those ≥75 is not known. In this study, we aim to investigate how age, coupled with various clinical risk factors, affects AIS severity within these two age categories. Methods : This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages >65 and <75 as well as those ≥75 was analyzed using univariate analysis. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to examine the association of specific baseline risk factors or comorbidities associated with worsening or improving neurologic functions. The primary functions were risk factors associated with improving or worsening neurologic outcome in each age category. Results : Adjusted multivariate analysis showed that AIS population of patients >65 and <75 experiencing heart failure (OR = 4.398, 95% CI, 3.912 – 494.613, P = 0.002) and elevated HDL levels (OR = 1.066, 95% CI, 1.009 – 1.126, P = 0.024) trended towards worsening neurologic functions while patients experiencing obesity (OR = 0.177, 95% CI, 0.041 – 0.760, P = 0.020) exhibited improving neurologic functions. For the patients ≥75 years of age, direct admission (OR = 0.270, 95% CI, 0.085 – 0.856, P = 0.026) was associated with improvement of patients treated in the telestroke. Conclusions : Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for >65 and <75 and ≥75 age categories. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions among AIS for patients aged >65 and <75. Obese patients and individuals ≥75 years who were directly admitted were most likely to exhibit improving neurologic functions. Most importantly, findings from this study reveal specific risk factors that can be managed to improve the care in older stroke patients treated in the telestroke network.

scholarly journals Trends in cardiovascular risk factors and treatment goals in patients with diabetes in Singapore-analysis of the SingHealth Diabetes Registry

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259157
Author(s):  
Liang Feng ◽  
Amanda Lam ◽  
David Carmody ◽  
Ching Wee Lim ◽  
Gilbert Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Glycated Hemoglobin ◽  
Temporal Trends ◽  
Vascular Complications ◽  
Housing Type ◽  
Risk Factor Control ◽  
Mixed Effect ◽  
Diabetes Registry ◽  
Adjusted Risk

Background Asian populations are at high risk of diabetes and related vascular complications. We examined risk factor control, preventive care, and disparities in these trends among adults with diabetes in Singapore. Methods The sample included 209,930 adults with diabetes aged≥18 years from a multi-institutional SingHealth Diabetes Registry between 2013 and 2019 in Singapore. We performed logistic generalized estimating equations (GEEs) regression analysis and used linear mixed effect modeling to evaluate the temporal trends. Results Between 2013 and 2019, the unadjusted control rates of glycated hemoglobin (4.8%, 95%CI (4.4 to 5.1) and low-density lipoprotein cholesterol (LDL-C) (11.5%, 95%CI (11.1 to 11.8)) improved, but blood pressure (BP) control worsened (systolic BP (SBP)/diastolic BP (DBP) <140/90 mmHg: -6.6%, 95%CI (-7.0 to -6.2)). These trends persisted after accounting for the demographics including age, gender, ethnicity, and housing type. The 10-year adjusted risk for coronary heart disease (CHD) (3.4%, 95% (3.3 to 3.5)) and stroke (10.4%, 95% CI (10.3 to 10.5)) increased. In 2019, the control rates of glycated hemoglobin, BP (SBP/DBP<140/90 mmHg), LDL-C, each, and all three risk factors together, accounted for 51.5%, 67.7%, 72.2%, and 24.4%, respectively. Conclusions Trends in risk factor control improved for glycated hemoglobin and LDL-C, but worsened for BP among diabetic adults in Singapore from 2013 to 2019. Control rates for all risk factors remain inadequate.

Abstract P127: Racial Disparities in Risk Factor Control in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christina Parrinello ◽  
Ina Rastegar ◽  
Job G Godino ◽  
Michael D Miedema ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Racial Disparities ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Tight Control ◽  
Risk Factor Control ◽  
Atherosclerosis Risk In Communities

Background: Racial disparities in risk factor control have been documented in middle-aged adults, but much less is known about older adults with diabetes. Our findings will inform clinical guidelines on appropriate risk factor control in older adults with diabetes. Methods: In 2011-13, 6,538 ARIC participants attended visit 5, and 4,988 provided data on all key covariates used in these analyses. Of these, 31% had diagnosed diabetes (N=1,561, 72% white, mean age=75 years) and were included in this study. Tight control of risk factors was defined according to American Diabetes Association guidelines: hemoglobin A1c <7%; low-density lipoprotein cholesterol <100 mg/dL; systolic blood pressure (BP) <140 mmHg and diastolic BP <80 mmHg. We evaluated risk factor control overall and by race. We used logistic regression and predictive margins to assess independent associations of race with tight risk factor control. Results: Among older adults with diabetes, 64% used glucose-lowering medication, 70% lipid-lowering medication and 82% BP-lowering medication. Only 5% of participants did not take medication for any of these risk factors. Tight control was observed in 72% for glucose, 64% for lipids and 70% for BP. Only 34% had tight control of all three. A higher proportion of whites than blacks consistently achieved tight control ( Figure ). In multivariable analyses of persons with diabetes who were treated for risk factors, racial disparities in tight control of lipids and BP remained significant: adjusted prevalence ratios and 95% CIs (white vs black) were 1.04 (0.91, 1.17) for glucose, 1.21 (1.08-1.34) for lipids, 1.15 (1.03-1.26) for BP, and 1.33 (0.95, 1.70) for tight control of all three risk factors. Conclusions: Our results highlight racial disparities in risk factor control in older adults with diabetes that were not explained by demographic or clinical characteristics. Further studies are needed to elucidate the determinants of disparities in risk factor control and strategies to address these.

Abstract TMP98: Could Mobile Health be an Effective Strategy for Enhancing Stroke Prevention?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shimeng Liu ◽  
Wuwei Feng ◽  
Pratik Y Chhatbar ◽  
Bruce I Ovbiagele
Keyword(s):  
Risk Factors ◽  
Smoking Cessation ◽  
Risk Factor ◽  
Glycemic Control ◽  
Mobile Health ◽  
Meta Analysis ◽  
Vascular Risk Factor ◽  
Smoking Abstinence ◽  
Vascular Risk ◽  
Risk Factor Control

Background: The overwhelming majority of strokes can be prevented via optimal vascular risk factor control. However, there remains an evidence practice gap with regard to treatment of vascular risk factors. With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge these treatment gaps and reduce the global burden of stroke. Objective: To evaluate the effectiveness of mHealth in vascular risk factor control through a systemic review and meta-analysis. Methods: We searched PubMed from January 1, 2000 to May 17, 2016 using keywords: mobile health, mhealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed the long-term (at 6 months) effect of mHealth. Results: Of 79 articles identified, 13 of them met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater HbA1c reduction at 6 months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P =0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74,-0.04], P =0.03). mHealth also led to relatively higher smoking abstinence rates at 6 months (7 studies; 9,514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P <0.0001). Conclusion: Use of mHealth improves glycemic control and smoking abstinence rates, two factors that may lead to better stroke outcomes. Future mHealth studies should focus on modifying premier vascular risk factors like hypertension, specifically in people with or at risk of stroke.

Abstract 3000: Epidemiology of Cerebrovascular Diseases Among Chinese with Diabetes Mellitus in Toronto: A Retrospective Ten Years Case-mix Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Susy Lam ◽  
Joseph Y Chu
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
Small Vessels ◽  
Guideline Values ◽  
Co Morbidity ◽  
Stroke Type

BACKGROUND: An article published in Neurology Asia(2006;11:13-18) by Chu etal provided essential data to investigate whether specific genetic or environmental differences exist within the diabetic-Chinese stroke community. Insight into distinctive epidemiologic and cerebrovascular patterns will bring forth effectively focused treatment and prevention. From that basis, we hypothesized: Chinese who had stroke-history within 15 years are more commonly diabetic than Europeans, and Chinese more frequently have small vessels disease (SVD) than Europeans. METHODS: Patients seen during 2001-2011 at the Toronto Queensway Professional Center Neurology clinic and at William Osler Health System, Brampton Site, were investigated. Chinese diabetic stroke patients were selected by last name and birth country; similarly diagnosed European patients were age-sex matched correspondingly. Risk factors were acknowledged if patients were given explicit medical treatments. Otherwise, guideline values were obtained from the WHO criteria. Data was collected through screening patient charts for the following: diabetic prevalence through screening stroke patients (122 Chinese, 880 European) excluding TIAs, subarachnoid and subdural haemorrhages; etiology and stroke type comparison in patients with DM (48 Chinese, 127 European); risk factors differences between Chinese and Europeans with DM. Odds ratios and unpaired two-sample t-testing were used to confirm significance. RESULTS: Significance confirmed (P<0.05): Chinese had higher DM and stroke incidence than Europeans (28.7% vs. 23.2%). Diabetic Chinese more frequently had SVD (51.1% vs. 44.1%), specifically lacunar stroke (47.9% vs. 36.4%). The co-morbidity of SVD risk factors of hypertension, hyperlipidemia and overweight were more frequent in Chinese (Table 1.0). Furthermore, SVD frequency dominated over large vessels disease (LVD) in the Chinese (Table 1.1). Table 1.0 - RISK FACTOR INCIDENCE Overweight HBP HPL Chinese, SVD 26.9% 53.8% 36.5% European, SVD 16.5% 33.1% 23.6% OR Chinese/Euro.1.86 2.36 1.86 Table 1.1 - STROKE TYPE AND RISK Overweight, SVD Overweight, LVD Hyperlipidemia, SVD Hyperlipidemia, LVD Hypertension, SVD Hypertension, LVD : Chinese 26.9% 7.7% 36.5% 15.0% 53.8% 25.0% OR SVD/LVD 4.42 3.26 3.50 European 16.5% 7.9% 23.6% 15.0% 33.1% 26.0% OR SVD/LVD 2.32 1.76 1.41 CONCLUSIONS: Chinese with stroke are more frequently diabetic than Europeans. Diabetic Chinese are especially susceptible to small vessels disease and certain stroke risk factors are more frequent compared to the Europeans. Risk factor prevalence and stroke types differ considerably between Chinese and Europeans within Toronto, which may imply that specific treatment strategies are required to target towards each population.

Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dinesh V Jillella ◽  
Sara Crawford ◽  
Anne S Tang ◽  
Rocio Lopez ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Regression Models ◽  
Stroke Risk ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Risk Factor Prevalence ◽  
Urban Rural ◽  
Artery Disease

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.

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