Treatment in a Stroke Unit and Risk Factor Control Reduce Recurrent Stroke Risk

• Published in: Cerebrovascular diseases extra Vol. 12; no. 2; pp. 85 - 92
• Main Authors: Shani, S.D., Varma, Ravi Prasad, Sarma, Sankara P., Sreelakshmi, R.S., Harikrishnan, Ramachandran, Kutty, V. Raman, Sylaja, P.N.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 06-07-2022; Karger Publishers
• Subjects: Age; Blood pressure; Case-Control Studies; Cerebral Infarction; Cholesterol; Data collection; Diabetes; Diabetes Mellitus; Disease; Health care; Humans; Male; Original Paper; Patient compliance; Regression analysis; Risk Factors; Stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - prevention & control; Transient ischemic attack; Stroke recurrence; Stroke unit; Average attributable fraction; Risk factor control
• ISSN: 1664-5456; 1664-5456
• DOI: 10.1159/000525716

Introduction: Risk factor control is an important predictor of risk of stroke recurrence. The attributable fraction which estimates the excess risk among the exposed stroke survivors has not been studied previously. We studied the attributable fraction for stroke recurrence in consecutive incident cases of recurrent stroke. Methods: A case-control study with incident cases of recurrent stroke and controls matched for age and poststroke period was done. A structured interview was done to collect data on sociodemographic variables, lifestyle, and medication adherence. The risk factors, treatment of index stroke, and outcome were collected. Logistic regression analysis was done to find out the factors associated with stroke recurrence. Attributable fraction and average attributable fraction were calculated. Results: Among the 103 matched pairs, more than 70% were rural residents. Male gender (OR 2.59; 95% CI 1.05–6.42), the presence of depression (OR 8.67; 95% CI 2.80–26.84), memory problem (OR 10.12; 95% CI 2.48–41.34), uncontrolled diabetes (OR 3.19; 95% CI 1.42–7.19), cardioembolic stroke (OR 4.45; 95% CI 1.12–17.62), and index stroke not being treated in a stroke unit (OR 6.60; 95% CI 2.86–15.23) were associated with increased risk of stroke recurrence. The maximum average attributable fraction for stroke recurrence risk was attributed to index stroke not being treated in the stroke unit and uncontrolled diabetes. Conclusion: The index stroke treated in a comprehensive stroke care unit and control of risk factors can reduce recurrent stroke risk among stroke survivors. This population-attributable risk is important in planning secondary stroke prevention strategies.