Danielle Ní Chróinín1, Chantelle Ní Chróinín2, Layan Akijian3, Elizabeth L Callaly3, Niamh Hannon3, Lisa Kelly3, Michael Marnane3, Áine Merwick3, Órla Sheehan3, Gillian Horgan3, Joseph Duggan3, Lorraine Kyne3, Eamon Dolan4, Seán Murphy3, David Williams5, Peter J Kelly3. 1. Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland. dmmnic@umail.ucc.ie. 2. Mater Misericordiae University Hospital, Dublin 7, Ireland. 3. Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland. 4. Stroke and Hypertension Unit, Connolly Memorial Hospital, Dublin, Ireland. 5. Department of Geriatric and Stroke Medicine, Beaumont Hospital/RCSI, Dublin 9, Ireland.
Abstract
BACKGROUND: Few population-based studies have assessed lipid adherence to international guidelines for primary and secondary prevention in stroke/transient ischaemic attack (TIA) patients. AIMS: This study aims to evaluate adherence to lipid-lowering therapy (LLT) guidelines amongst patients with ischaemic stroke/TIA. METHODS: Using hot and cold pursuit methods from multiple hospital/community sources, all stroke and TIA cases in North Dublin City were prospectively ascertained over a 1-year period. Adherence to National Cholesterol Education Programme (NCEP) III guidelines, before and after index ischaemic stroke/TIA, was assessed. RESULTS: Amongst 616 patients (428 ischaemic stroke, 188 TIA), total cholesterol was measured following the qualifying event in 76.5% (471/616) and low-density lipoprotein (LDL) in 60.1% (370/616). At initial stroke/TIA presentation, 54.1% (200/370) met NCEP III LDL goals. Compliance was associated with prior stroke (odds ratio [OR] 2.19, p = 0.02), diabetes (OR 1.91, p = 0.04), hypertension (OR 1.57, p = 0.03), atrial fibrillation (OR 1.78, p = 0.01), pre-event LLT (OR 2.85, p < 0.001) and higher individual LDL goal (p = 0.001). At stroke/TIA onset, 32.7% (195/596) was on LLT. Nonetheless, LDL exceeded individual NCEP goal in 29.2% (56/192); 21.6% (53/245) warranting LLT was not on treatment prior to stroke/TIA onset. After index stroke/TIA, 75.9% (422/556) was on LLT; 15.3% (30/196) meeting NCEP III criteria was not prescribed a statin as recommended. By 2 years, actuarial survival was 72.8% and 11.9% (59/497) experienced stroke recurrence. No association was observed between initial post-event target adherence and 2-year outcomes. CONCLUSIONS: In this population-based study, LLT recommended by international guidelines was under-used, before and after index stroke/TIA. Strategies to improve adherence are needed.
BACKGROUND: Few population-based studies have assessed lipid adherence to international guidelines for primary and secondary prevention in stroke/transient ischaemic attack (TIA) patients. AIMS: This study aims to evaluate adherence to lipid-lowering therapy (LLT) guidelines amongst patients with ischaemic stroke/TIA. METHODS: Using hot and cold pursuit methods from multiple hospital/community sources, all stroke and TIA cases in North Dublin City were prospectively ascertained over a 1-year period. Adherence to National Cholesterol Education Programme (NCEP) III guidelines, before and after index ischaemic stroke/TIA, was assessed. RESULTS: Amongst 616 patients (428 ischaemic stroke, 188 TIA), total cholesterol was measured following the qualifying event in 76.5% (471/616) and low-density lipoprotein (LDL) in 60.1% (370/616). At initial stroke/TIA presentation, 54.1% (200/370) met NCEP III LDL goals. Compliance was associated with prior stroke (odds ratio [OR] 2.19, p = 0.02), diabetes (OR 1.91, p = 0.04), hypertension (OR 1.57, p = 0.03), atrial fibrillation (OR 1.78, p = 0.01), pre-event LLT (OR 2.85, p < 0.001) and higher individual LDL goal (p = 0.001). At stroke/TIA onset, 32.7% (195/596) was on LLT. Nonetheless, LDL exceeded individual NCEP goal in 29.2% (56/192); 21.6% (53/245) warranting LLT was not on treatment prior to stroke/TIA onset. After index stroke/TIA, 75.9% (422/556) was on LLT; 15.3% (30/196) meeting NCEP III criteria was not prescribed a statin as recommended. By 2 years, actuarial survival was 72.8% and 11.9% (59/497) experienced stroke recurrence. No association was observed between initial post-event target adherence and 2-year outcomes. CONCLUSIONS: In this population-based study, LLT recommended by international guidelines was under-used, before and after index stroke/TIA. Strategies to improve adherence are needed.
Authors: Danielle Ní Chróinín; Kjell Asplund; Signild Åsberg; Elizabeth Callaly; Elisa Cuadrado-Godia; Exuperio Díez-Tejedor; Mario Di Napoli; Stefan T Engelter; Karen L Furie; Sotirios Giannopoulos; Antonio M Gotto; Niamh Hannon; Fredrik Jonsson; Moira K Kapral; Joan Martí-Fàbregas; Patricia Martínez-Sánchez; Haralampos J Milionis; Joan Montaner; Antonio Muscari; Slaven Pikija; Jeffrey Probstfield; Natalia S Rost; Amanda G Thrift; Konstantinos Vemmos; Peter J Kelly Journal: Stroke Date: 2013-01-03 Impact factor: 7.914
Authors: Andrew J Mullard; Mathew J Reeves; Bradley S Jacobs; Rashmi U Kothari; Gretchen L Birbeck; Kate Maddox; Stacey Stoeckle-Roberts; Susan Wehner Journal: Stroke Date: 2005-12-08 Impact factor: 7.914
Authors: Zeljko Reiner; Alberico L Catapano; Guy De Backer; Ian Graham; Marja-Riitta Taskinen; Olov Wiklund; Stefan Agewall; Eduardo Alegria; M John Chapman; Paul Durrington; Serap Erdine; Julian Halcox; Richard Hobbs; John Kjekshus; Pasquale Perrone Filardi; Gabriele Riccardi; Robert F Storey; David Wood Journal: Eur Heart J Date: 2011-06-28 Impact factor: 29.983
Authors: Katiuscia Nardi; Stefan Engelter; Daniel Strbian; Hakan Sarikaya; Marcel Arnold; Federica Casoni; Gary A Ford; Charlotte Cordonnier; Philippe Lyrer; Régis Bordet; Lauri Soinne; Henrik Gensicke; Patrick Duriez; Ralf W Baumgartner; Turgut Tatlisumak; Didier Leys Journal: Neurology Date: 2012-07-25 Impact factor: 9.910
Authors: Eric E Smith; Wenqin Pan; DaiWai Olson; Mathew J Reeves; Bruce Ovbiagele; Eric D Peterson; Gregg C Fonarow; Lee H Schwamm Journal: Stroke Date: 2009-12-24 Impact factor: 7.914
Authors: Catriona Murphy; Kathleen Bennett; Tom Fahey; Emer Shelley; Ian Graham; Rose Anne Kenny Journal: BMJ Open Date: 2015-07-13 Impact factor: 2.692
Authors: Mari Nordbø Gynnild; Steven H J Hageman; Olav Spigset; Stian Lydersen; Ingvild Saltvedt; Jannick A N Dorresteijn; Frank L J Visseren; Hanne Ellekjær Journal: Open Heart Date: 2022-04