Abstract P279: Trends in Treatment and Control of Vascular Risk Factors in U.S. Stroke Survivors: Results from the National Health and Nutrition Examination Surveys (NHANES), 1999-2008

Abstract

Introduction: Treatment and control of vascular risk factors reduce the likelihood of recurrent stroke in stroke survivors. Current nationally-representative data are sparse regarding prevention treatment and control rates. Methods: We evaluated rates of blood pressure, cholesterol, and dysglycemia treatment and control (to goal levels) in a weighted sample of 936 adult stroke survivors using data from five consecutive two-year NHANES cycles, 1999 to 2008. We used weighted linear regression to estimate time trends. Results: The Figure shows sex-specific trends in mean systolic and diastolic blood pressure, total and HDL cholesterol, glucose, and hemoglobin A1c from 1999 to 2008. All measures remained unchanged over the study period, except for a decrease in mean (SE) systolic blood pressure in women from 142 (3.4) to 131 (1.9) mmHg, and total cholesterol in men from 5.4 (0.2) to 4.6 (0.2) mmol/L (p < 0.05 for both). Blood pressure treatment rates did not change in either sex, but control rates increased in women from 23% (11 of 38) in 1999–2000 to 59% (50 of 93) in 2007–2008 (p = 0.03). Cholesterol treatment rates increased in women from 28% (19 of 73) to 34% (51 of 127) (p = 0.01) without increases in control to goal levels. In contrast, cholesterol control rates increased in men from 62% (17 of 23) to 78% (40 of 50) (p = 0.01). Dysglycemia treatment rates decreased in women from 20% (18 of 73) to 10% (15 of 127) (p = 0.02) but not in men, and control rates did not significantly change in either sex. Anti-platelet medication use also increased from 24% (36 of 157) to 34% (84 of 241) (p = 0.05). Conclusions: Despite improvements in blood pressure and cholesterol control rates in women and men, respectively, stroke secondary prevention through treatment and control of vascular risk factors remains substantially sub-optimal. Urgent action is needed to identify and close these gaps to reduce stroke morbidity and mortality in this high-risk group.