Secondary Prevention in Patients With Stroke Versus Myocardial Infarction: Analysis of 2 National Cohorts
Cyprien A Rivier1, Julian N Acosta1, Audrey C Leasure2
1Department of Neurology, Center for Brain and Mind Health Yale School of Medicine New Haven CT.
Insights
Patients with a history of stroke have poorer cardiovascular prevention compared to those with myocardial infarction (MI). This highlights a need to improve secondary prevention strategies for stroke survivors.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cardiovascular risk factors are similar for stroke and myocardial infarction (MI) patients.
- Preventive therapy implementation in stroke patients is less understood than in MI patients.
Purpose of the Study:
- To test the hypothesis that stroke patients have a worse cardiovascular prevention profile than MI patients.
- To compare secondary prevention adherence between stroke and MI cohorts.
Main Methods:
- Cross-sectional analysis of UK Biobank and All of Us Research Program data.
- Evaluation of low-density lipoprotein control, blood pressure control, statin use, antiplatelet therapy use, and a composite cardiovascular prevention score.
- Assessment of 14,760 participants (UK Biobank) and 7,315 participants (All of Us).
Main Results:
- Stroke patients had significantly lower odds of meeting all preventive criteria compared to MI patients in both cohorts.
- Lower odds observed for low-density lipoprotein control, blood pressure control, statin use, and antiplatelet therapy use in stroke patients.
- Race, ethnicity, and neighborhood deprivation influenced the odds of achieving a good cardiovascular prevention score.
Conclusions:
- Patients with stroke exhibit poorer cardiovascular prevention profiles and lower adherence to guideline-directed therapies than MI patients.
- Findings indicate a need to investigate the reasons for underuse of secondary prevention in stroke survivors.
- Targeted interventions may be necessary to improve secondary prevention in this population.
Background:
The implementation of preventive therapies among patients with stroke remains inadequately explored, especially when compared with patients with myocardial infarction (MI), despite sharing similar vascular risk profiles. We tested the hypothesis that participants with a history of stroke have a worse cardiovascular prevention profile in comparison to participants with MI.
Methods And Results:
In cross-sectional analyses within the UK Biobank and All of Us Research Program, involving 14 760 (9193 strokes, 5567 MIs) and 7315 (2948 strokes, 4367 MIs) participants, respectively, we evaluated cardiovascular prevention profiles assessing low-density lipoprotein (<100 mg/dL), blood pressure (systolic, <140 mm Hg; and diastolic, <90 mm Hg), statin and antiplatelet use, and a cardiovascular prevention score that required meeting at least 3 of these criteria. The results revealed that, within the UK Biobank, patients with stroke had significantly lower odds of meeting all the preventive criteria compared with patients with MI: low-density lipoprotein control (odds ratio [OR], 0.73 [95% CI, 0.68-0.78]; P<0.001), blood pressure control (OR, 0.63 [95% CI, 0.59-0.68]; P<0.001), statin use (OR, 0.45 [95% CI, 0.42-0.48]; P<0.001), antiplatelet therapy use (OR, 0.30 [95% CI, 0.27-0.32]; P<0.001), and cardiovascular prevention score (OR, 0.42 [95% CI, 0.39-0.45]; P<0.001). Similar patterns were observed in the All of Us Research Program, with significant differences across all comparisons (P<0.05), and further analysis suggested that the odds of having a good cardiovascular prevention score were influenced by race and ethnicity as well as neighborhood deprivation levels (interaction P<0.05 in both cases).
Conclusions:
In 2 independent national cohorts, patients with stroke showed poorer cardiovascular prevention profiles and lower adherence to guideline-directed therapies compared with patients with MI. These findings underscore the need to explore the reasons behind the underuse of secondary prevention in vulnerable stroke survivors.
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