Trends in Vascular Risk Factor Control Among US Adults With Prior Stroke: 1999 to 2023

Management of modifiable risk factors is key in the prevention of recurrent stroke. We investigated trends in vascular risk factors (hyperglycemia, hyperlipidemia, hypertension, and smoking) control among US adults with stroke.

We performed analyses of data from 1999 through 2023 National Health and Nutrition Examination Surveys participants with self-reported stroke. Meeting guideline-recommended targets for risk factor control was defined as hemoglobin A_1c <6.5% without diabetes or hemoglobin A_1c <7.0% with diabetes, low-density lipoprotein cholesterol <70 mg/dL, blood pressure <130/80 mm Hg, and nonsmoking. Age-standardized mean hemoglobin A_1c, low-density lipoprotein, and blood pressure and prevalence of meeting each recommended target were calculated for each epoch (1999 through 2002, 2003 through 2006, 2007 through 2010, 2011 through 2014, 2015 through 2020, and 2021 through 2023).

Mean hemoglobin A_1c increased from 5.7% (95% CI, 5.5-5.9) in 1999 through 2002 to 6.0% (95% CI, 5.7-6.3) in 2021 through 2023 (P-trend=0.04) and LDL decreased from 125.9 mg/dL (95% CI, 119.4-132.4) in 1999 through 2002 to 115.6 mg/dL (95% CI, 107.8-123.5) in 2021 through 2023 (P-trend<0.001), whereas blood pressure was largely stable. The prevalence of meeting glycemia guidelines decreased from 90.7% (95% CI, 85.9%-95.6%) in 1999 through 2002 to 83.9% (95% CI, 70.2%-97.5%) in 2021-2023 (P-trend=0.03), whereas the prevalence of meeting lipid guidelines increased from 1999 through 2002 (5.1% [95% CI, 0%-11.0%]) to 2021 through 2023 (13.6% [95% CI, 6.9%-20.4%; P-trend=0.002). The prevalence of meeting smoking and blood pressure guidelines was stable. Fewer than 10% of individuals met guidelines for all 4 risk factors over the study.

In this nationally representative sample of US adults with stroke, <10% met guideline recommendations for all risk factors with an overall stable trend. These results suggest that efforts aimed at glycemia, blood pressure, and lipid control and smoking cessation could be improved to reduce the burden of recurrent stroke.