Related Experiment Video
Updated: Jul 9, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Long-term risk-factor control and secondary prevention are insufficient after first TIA: Results from QregPV
Johan-Emil Bager1,2, Katarina Jood3,4, Annika Nordanstig3
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Secondary prevention after a first transient ischemic attack (TIA) showed initial improvements in risk factors like blood pressure and cholesterol but then stagnated. Long-term treatment adherence decreased, indicating a need for better secondary prevention strategies in TIA patients.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Transient ischemic attack (TIA) is a critical warning sign for stroke.
- Long-term risk-factor management and secondary prevention strategies following a first TIA are not well-defined.
- Effective secondary prevention is crucial to reduce recurrent cerebrovascular events.
Purpose of the Study:
- To evaluate long-term risk-factor control and secondary prevention treatment adherence in patients after their first TIA.
- To analyze trends in blood pressure, LDL cholesterol, smoking status, and medication use over five years post-TIA.
- To identify gaps in care and potential areas for improvement in secondary prevention.
Main Methods:
- Retrospective analysis of a Swedish primary-care register (QregPV) for patients diagnosed with a first TIA between 2010-2012.
- Follow-up data collected for up to five years, assessing blood pressure, LDL-C, smoking, and use of antihypertensives, statins, and antiplatelet treatment/oral anticoagulation (APT/OAC).
- Logistic mixed-effect models used to analyze changes in risk-factor control and treatment over time.
Main Results:
- Initial improvements in achieving target blood pressure (<140/90 mmHg), LDL-C (<2.6 mmol/L), and non-smoking status were observed in the first year post-TIA (20% to 33%).
- These improvements in risk-factor control stagnated between years two and five.
- While 47% of patients achieved complete secondary prevention treatment in the first year, continued follow-up showed a yearly decrease in treatment adherence.
Conclusions:
- Risk-factor control following a first TIA in this Swedish cohort was suboptimal.
- There is significant potential to enhance secondary prevention treatment adherence in patients after a TIA.
- Sustained management and monitoring are essential to maintain secondary prevention benefits long-term.
Introduction:
Long-term risk-factor control and secondary prevention are not well characterized in patients with a first transient ischemic attack (TIA). With baseline levels as reference, we compared primary-care data on blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and use of antihypertensives, statins and antiplatelet treatment/oral anticoagulation (APT/OAC) during 5 years after a first TIA.
Patients And Methods:
Patients in QregPV, a Swedish primary-care register for the Region of Västra Götaland, with a first TIA discharge diagnosis from wards proficient in stroke care 2010 to 2012 were identified and followed up to 5 years. BP, LDL-C, smoking, use of antihypertensives, statins, APT/OAC, and achievement of target levels were calculated. We used logistic mixed-effect models to analyze the effect of follow-up over time on risk-factor control and secondary prevention treatment.
Results:
We identified 942 patients without prior cerebrovascular disease who had a first TIA. Compared to baseline, the first year of follow-up was associated with improvements in concomitant attainment of BP <140/90 mmHg, LDL-C < 2.6 mmol/L and non-smoking, which rose from 20% to 33% (OR 2.08, 95% CI 1.38-3.13), but then stagnated in years 2-5. In the first year of follow-up, 47% of patients had complete secondary prevention treatment (antihypertensives, APT/OAC and statin), but continued follow-up was associated with a yearly decrease in secondary prevention treatment (OR 0.94, 95% CI 0.94-0.98).
Conclusion:
Risk-factor control was inadequate, leaving considerable potential for improved secondary prevention treatment after a first TIA in Swedish patients followed up to 5 years.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
