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Comprehensive Prestroke Risk Factor Control and Functional Outcomes After Acute Ischemic Stroke
Joon-Tae Kim1, Ji Sung Lee2, Hyunsoo Kim1
1Department of Neurology Chonnam National University Hospital, Chonnam National University Medical School Gwangju Korea.
Insights
Effective management of prestroke risk factors (RFs) is linked to better functional recovery after ischemic stroke. Comprehensive control of hypertension, diabetes, dyslipidemia, and atrial fibrillation improves 3-month outcomes, regardless of RF count.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- The association between comprehensive prestroke risk factor (RF) management and 3-month functional outcomes after ischemic stroke is not well-established.
- Major RFs for ischemic stroke include hypertension, diabetes, dyslipidemia, and atrial fibrillation.
Purpose of the Study:
- To investigate if comprehensive prestroke RF management is associated with improved 3-month functional outcomes after ischemic stroke.
- To evaluate the impact of RF control levels (well, partially, poorly controlled) on functional independence post-stroke.
Main Methods:
- Analysis of ischemic stroke patients from the CRCS-K-NIH registry (2011-2022).
- Categorization of prestroke RF management as well controlled, partially controlled, or poorly controlled based on treatment and biomarker criteria.
- Primary outcome: 3-month modified Rankin Scale score of 0-2 (functional independence).
Main Results:
- Among 63,570 patients with at least one RF, 35.8% were well controlled, 35.6% partially controlled, and 28.6% poorly controlled.
- Good 3-month outcomes were observed in 66.0% (1 RF), 60.8% (2 RFs), and 55.0% (≥3 RFs).
- Both well-controlled (aOR 1.22) and partially controlled (aOR 1.14) groups showed significantly higher odds of good 3-month outcomes compared to the poorly controlled group, irrespective of RF burden.
Conclusions:
- Comprehensive prestroke RF management, defined by specific criteria, is independently associated with better 3-month functional outcomes.
- Effective prestroke management of RFs may enhance poststroke functional recovery, irrespective of the number of RFs present.
Background:
Whether comprehensive prestroke risk factor (RF) management-defined by the extent to which existing major RFs meet prespecified treatment and biomarker criteria-is associated with 3-month functional outcomes after ischemic stroke remains unclear.
Methods:
We analyzed patients with ischemic stroke from the CRCS-K-NIH (Clinical Research Collaborations for Stroke in Korea-National Institutes for Health) registry (2011-2022), a multicenter stroke registry in Korea. Hypertension, diabetes, dyslipidemia, and atrial fibrillation were considered as major RFs for ischemic stroke. Comprehensive prestroke RF management was categorized as well controlled (all present RFs meeting study-defined control criteria), partially controlled (some RFs meeting this criteria), or poorly controlled (no RFs meeting this criteria). The primary outcome was 3-month modified Rankin Scale score of 0 to 2, indicating functional independence (good outcome).
Results:
Among 63 570 patients with ≥1 major RFs, 28.6% were poorly controlled, 35.6% partially controlled, and 35.8% well controlled. The rate of 3-month good outcome was 66.0% among those with 1 RF, 60.8% in 2, and 55.0% in ≥3. After multivariable adjustment, both well-controlled and partially controlled groups had significantly higher odds of achieving good 3-month outcomes compared with poorly controlled patients, consistently across RF burden strata(well controlled: adjusted odds ratio, 1.16 [95% CI, 1.08-1.25] for 1 RF, 1.34 [95% CI, 1.21-1.48] for 2, and 1.23 [95% CI, 1.03-1.48] for ≥3; partially controlled: 1.16 [95% CI, 1.06-1.26] for 2; 1.22 [95% CI, 1.05-1.42] for ≥3) and in the overall cohort (well controlled: 1.22 [95% CI, 1.15-1.29], partially controlled: 1.14 [95% CI, 1.07-1.22]).
Conclusions:
Comprehensive prestroke RF management, defined by study-specific treatment- and biomarker-based criteria, was independently associated with a higher likelihood of favorable 3-month outcomes across levels of RF burden. These findings suggest that effective prestroke management of existing RFs may improve poststroke functional outcomes, regardless of the number of RFs present.
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