October 17, 2017
Despite many prevention initiatives, the prevalence of conventional stroke risk factors, including hypertension, diabetes, dyslipidemia, drug abuse, and smoking, actually appears to be on the rise among new ischemic stroke patients in the United States, a new study shows.
Other vascular conditions, such as chronic renal failure, coronary artery disease, and carotid stenosis, also appear to be increasing in the acute ischemic stroke population. These observations come from a new analysis of data from the Nationwide Inpatient Sample, which includes 922,451 hospitalizations for acute ischemic stroke. The authors say this represents "the most comprehensive assessment to date of temporal trends in the prevalence of major stroke risk factors."
The study was published online in Neurology on October 11.
"Our data show that all risk factors increased from 2004 to 2014 and the prevalence of raised cholesterol more than doubled during this time. These are truly alarming findings," lead author, Fadar Oliver Otite, MD, University of Miami Miller School of Medicine, Florida, told Medscape Medical News.
"While we are putting a great deal of effort into trying to control cardiovascular risk factors, this is not adequate. We need more coordinated strategies to try and tackle this problem," he added.
However, an accompanying editorial points out some limitations of the study and cautions against interpreting the data at face value. Results of the study show that across the 2004–2014 period, 92.5% of patients with acute ischemic stroke had one or more risk factors. Overall the age- and sex-adjusted prevalence of hypertension was 79%; diabetes, 34%; dyslipidemia, 47%; smoking, 15%; and drug abuse, 2%. In addition, 13% of patients had carotid stenosis, 12% had chronic renal failure, and 27% had coronary artery disease.
The analysis suggested that during the study period the prevalence of hypertension increased annually by 1.4%, diabetes by 2%, dyslipidemia by 7%, smoking by 5%, and drug abuse by 7%. Prevalence of chronic renal failure increased annually by 13%, carotid stenosis by 6%, and coronary artery disease by 1%.
During the whole 10 years of the study, diabetes prevalence increased from 30.7% in 2004 to 37.5% in 2014 in all patients, with higher rates in Hispanics and blacks than in whites. By 2014, 50% of Hispanic participants with acute ischemic stroke had diabetes. Stroke admissions with both hypertension and diabetes increased from 25.1% in 2004 to 34.2% in 2014.
Overall dyslipidemia prevalence more than doubled during the study period — from 28.9% in 2004 to 58.6% in 2014. Admissions with concomitant hypertension, diabetes, and dyslipidemia increased by more than 200% from 9.4% in 2004 to 23.7% in 2014. In terms of other vascular diseases, chronic renal failure saw the largest increase — from 4.8% in 2004 to 15.0% in 2014.
'Alarming' Increase in Stroke Risk Factors - Medscape - Oct 17, 2017.