Abstract P207: Medication Use for Secondary Stroke Prevention and Vascular RIsk Factor Modification Remains Low Among Americans

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Karen C Albright ◽  
Rikki M Tanner ◽  
Amelia K Boehme ◽  
T. Mark Beasley
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Medication Use ◽  
Prescription Medication ◽  
Vascular Risk Factor ◽  
Secondary Stroke Prevention ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
History Of ◽  
Factor Modification

Background: With a US prevalence of 795,000 strokes per year and stroke recurrence rates up to 20%, the objective of this study was to determine the prevalence of prescription medication use for secondary stroke prevention and vascular risk factor modification among noninstitutionalized US adults and compare medication use in Whites and Blacks. Methods: A cross-sectional study was performed as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Demographic, disease, and prescription medication use were obtained via a standardized interview. Participants were asked if they had ever been told by a health professional that they had hypertension, diabetes, high cholesterol, or a stroke. Additionally, participants were asked if they had taken or used any prescription medicine in the past month as well as the names of each prescription medication. Statistical analyses used NHANES sample weights to provide prevalence estimates for the US population. Results: Among 11,375 participants (21% Black, 47.6% men, age 20-80), medication use for secondary stroke prevention and vascular risk factors remained low (Table 1). Participants who reported taking either an antiplatelet agent or an anticoagulant with a history of stroke remained low (7.9% Whites vs 6.2% Blacks). More Blacks with hypertension reported taking blood pressure lowering agents (38.9 vs 36.1% Whites). Diabetic medication use was lower in Blacks reporting a history of diabetes (24.5 vs 25.7% Whites). Medication use rates were lowest in participants reporting high cholesterol, with more Whites reporting use of a cholesterol lowering medication (19.3 vs 14.6%; p<0.001). Conclusion: Despite the prevalence of stroke and vascular risk factors, only a small proportion of people at risk are on medications for secondary stroke prevention and vascular risk factor modification. Overall, Blacks were taking fewer medications for secondary stroke prevention and vascular risk factor modification with the exception of anti-hypertension medication.

Vascular cognitive impairment

2020 ◽  
pp. 454-463
Author(s):  
Joanne A. Byars ◽  
Ricardo E. Jorge
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Severe Form ◽  
Functional Change ◽  
Vascular Pathology ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
Factor Modification

Vascular cognitive impairment (VCI)—vascular dementia (VasD) in its severe form—is cognitive impairment due to cerebral ischaemic or haemorrhagic disease. VasD is the second most common cause of dementia in the United States. VCI and Alzheimer’s disease can coexist and synergistically worsen each other. Clinical features of VCI can vary, depending on which areas of the brain the vascular pathology affects. Individuals without a history of clinical stroke can still have VCI; small-vessel cerebrovascular disease can present as an insidious cognitive decline, rather than an abrupt functional change. Neuroimaging plays a key role in diagnosing VCI and distinguishing it from other aetiologies of cognitive impairment. Aggressive vascular risk factor modification helps prevent VCI and improves outcomes in VCI, and represents the most important intervention for this condition. Early detection of VCI maximizes the effectiveness of vascular risk factor modification. Cholinesterase inhibitors and memantine may offer some cognitive benefit in VCI.

scholarly journals The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme: for a Randomised Controlled Trial Protocol

2019 ◽  
Author(s):  
Marah Elfghi ◽  
Fionnuala Jordan ◽  
Denise Dunne ◽  
Irene Gibson ◽  
Jennifer Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Arterial Disease ◽  
Treatment Goals ◽  
Intervention Programme ◽  
Risk Factor Modification ◽  
History Of ◽  
Peripheral Arterial ◽  
Modification Intervention ◽  
Factor Modification

Abstract Background: Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.Methods: This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events.Discussion: This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high quality, well-powered clinical trial.

scholarly journals Stroke and air pollution. a worldwide public health problem

2020 ◽  
pp. 19-22
Author(s):  
M. Giroud ◽  
◽  
J. Reis ◽  
Keyword(s):  
Public Health ◽  
Air Pollution ◽  
Risk Factor ◽  
Public Health Problem ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Local Data ◽  
Public Health Policies ◽  
History Of ◽  
Ischemic Attack

After myocardial infarction, stroke is now associated with air pollution. From local data and literature, we report the strength of the association between air pollution and stroke. We try to understand the biological mechanisms between exposure to air pollutants and stroke risk. The association between air pollution and stroke is strong, confirmed and real. Air pollution and small particulate matter are the most toxic. Patients with classical neuro-vascular risk factors or a history of stroke or transient ischemic attack are at risk of stroke induced by air pollution. Air pollution is a serious modifiable risk factor for stroke and a silent killer inducing stroke. This new neuro-vascular risk factor is useful for public health policies.

scholarly journals The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme: for a Randomised Controlled Trial Protocol

2021 ◽  
Author(s):  
Marah Elfghi ◽  
Fionnuala Jordan ◽  
Denise Dunne ◽  
Irene Gibson ◽  
Jennifer Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Arterial Disease ◽  
Treatment Goals ◽  
Intervention Programme ◽  
Risk Factor Modification ◽  
History Of ◽  
Peripheral Arterial ◽  
Modification Intervention ◽  
Factor Modification

Abstract Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

scholarly journals The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme: for a Randomised Controlled Trial Protocol

2020 ◽  
Author(s):  
Marah Elfghi ◽  
Fionnuala Jordan ◽  
Denise Dunne ◽  
Irene Gibson ◽  
Jennifer Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Arterial Disease ◽  
Treatment Goals ◽  
Intervention Programme ◽  
Risk Factor Modification ◽  
History Of ◽  
Peripheral Arterial ◽  
Modification Intervention ◽  
Factor Modification

Abstract BackgroundPeripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease.Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors MethodsThis is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events.DiscussionThis study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high quality, well-powered clinical trial.Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

Abstract WP468: Follow Up After Stroke, Screening and Treatment Clinic: Advancing Post-Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Imama A Naqvi ◽  
Jennifer Andres ◽  
Charles Ruchalski ◽  
Sean V Cleymaet ◽  
Seung Kim ◽  
...  
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Vascular Risk Factor ◽  
Integrated Approach ◽  
Stroke Care ◽  
Secondary Stroke Prevention ◽  
Post Discharge ◽  
Post Stroke ◽  
Patient Reported

Objective: To assess feasibility and replicability of a multidisciplinary, specialized clinic in optimization of secondary stroke prevention and stroke related complications. Background: Recommendations exist for secondary stroke prevention, but it is unclear which outpatient model of care optimizes vascular risk factor control and decreases post-stroke complications most effectively. Designed after the Stroke Transitions, Education, and Prevention clinic in Houston, TX, the Follow up After Stroke, Screening and Treatment (FASST) clinic is an integrated, multidisciplinary, specialized clinic designed to optimize secondary stroke prevention. It provides post discharge stroke education and medication adherence counseling by Pharmacists, as well risk factor and complications management by Vascular Neurologists. Validated patient reported surveys screen for complications: depression, anxiety, sleep disorders, cognitive impairment, disability, social support, quality of life and functional status. Our approach and the characteristics of patients enrolled in the clinic is described. Methods: Patients attending one FASST clinic visit are included. Institutional Board Review approved consent is obtained. Demographic and clinical data are recorded including risk factors, surveys and outcome scores. Data is entered in Redcap and analyzed through the Statistical Analysis Software (SAS) program. Results: Of the 25 patients enrolled in the clinic, 83.3% are African American. A high prevalence of hyperlipidemia (100%) and hypertension (100%) exists, with 44% of patients having concomitant diabetes mellitus. Overall 26.7% screened positive for depression with PHQ-9, and 20% screened positive for anxiety with GAD-7. These patients were started on medications and referred for psychotherapy. Abnormal ESS scores were noted in 31.3% and directed for sleep apnea evaluation. Eighteen medical and pharmacy trainees rotated through the clinic. Conclusion: The FASST clinic represents a reproducible model for an integrated approach to post-stroke care. Adapted to academic centers across the country, a collaborative network would provide best practices, and measure patient reported outcomes to optimize stroke care.

scholarly journals The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme—for a randomised controlled trial protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M. Elfghi ◽  
F. Jordan ◽  
D. Dunne ◽  
I. Gibson ◽  
J. Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Arterial Disease ◽  
Treatment Goals ◽  
Intervention Programme ◽  
Risk Factor Modification ◽  
History Of ◽  
Peripheral Arterial ◽  
Modification Intervention ◽  
Factor Modification

Abstract Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors. Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

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