Risk Profile of Patients after Ischemic Stroke – Data Analysis from the IKTA Register

Česká verzia

Authors: Z. Kalita ^1,2; P. Brabec ¹; J. Švancara ¹; S. Voháňka ³; R. Jura ³; R. Mikulík ⁴; M. Kuliha ⁵; J. Neumann ⁶; J. Rajner ⁷; M. Král ⁸; J. Polívka ⁹; D. Václavík ¹⁰; R. Taláb ¹¹; J. Latta ¹²; O. Škoda ¹³; M. Barteys ¹⁴
Authors place of work: IBA MU, Brno ¹; Neurol. odd., Krajská nemocnice Tomáše Bati, a. s., Zlín ²; NK LF MU a FN Brno ³; NK LF MU a FN u sv. Anny v Brně ⁴; NK FN Ostrava ⁵; Neurol. odd., Krajská zdravotní, a. s. –Nemocnice Chomutov, o. z. ⁶; Neurol. odd., Městská nemocnice Ostrava ⁷; NK LF MU a FN Olomouc ⁸; NK LF UK a FN Plzeň ⁹; Neurol. odd., Vítkovická nemocnice a. s., Ostrava ¹⁰; NK LF UK a FN Hradec Králové ¹¹; Neurol. odd., Pardubická krajská nemocnice, a. s. ¹²; Neurol. odd., Nemocnice Jihlava ¹³; Neurol. odd., Nemocnice Vyškov, příspěvková organizace ¹⁴
Published in the journal: Cesk Slov Neurol N 2013; 76/109(3): 343-349
Category: Short Communication

Summary

Introduction:
Cardiovascular disease is the main cause of death in the Czech Republic. From 1958, we observe a decrease in mortality from cardiovascular disease as well as reduced incidence, including the incidence of stroke. Analysis of combined incidence of ischemic stroke in our country showed higher proportion of recurrence than in other western European countries. The incidence is affected by a post‑stroke patient risk profile. The aim of this research was to determine a proportion of patients with major risk of stroke (risk profile) in the Czech Republic. High incidence of risk factors might significantly contribute to high recurrence of stroke in our country.

Methods and results:
Total of 15,880 patients from 13 centers were entered into the IKTA register between 2010 and 2011. Risk factors (RF) were identified from anamnestic data, or based on abnormality detected and repeatedly verified with laboratory (or other) tests during hospitalization for acute stroke. We evaluated occurrence of three major well‑definable RFs: hypertension, dyslipidemia and diabetes mellitus (DM). Arterial hypertension was identified in 86.2% of patients and was followed by dyslipidemia (58.2%). DM was present in 34.9% of patients. Three or more RFs were found in 80.7% of post‑stroke patients, the most common was a combination of four RFs (20.5%).

Conclusion:
The incidence of RFs in patients after ischemic stroke in our study is significantly higher than that stated in the literature and this unfavorable risk profile may be the main cause of the high incidence of stroke and its recurrence.

Key words:
risk factors – risk profile – hypertension – dyslipidemia – diabetes mellitus

Zdroje

1. Sacco RL, Benjamin EJ, Brioderick JP, Dyken M, Easton JD, Feinberg WM et al. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Risk factor. Stroke 1997; 28(7): 1507– 1517.

2. Glodstein LB, Bushnell CD, Adams RJ, Appel LJ, Brain LT, Chaturvedi S et al. Guidelines for the primary prevention of stroke: a guidelines for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2011; 42(2): 517– 584.

3. Kalita Z, Keller O, Bar M, Mikulík R, Škoda O, Neumann J. Doporučený postup sekundární prevence recidivy po akutní cévní mozkové příhodě: mozkovém infarktu/ tranzitorní ischemické atace a hemoragické cévní mozkové příhodě. Cesk Slov Neurol N 2008; 71/ 104(3): 372– 378.

4. Lopez AD, Mathers C, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367(9524): 1747– 1757.

5. Roger VL, Go AS, Lloyd‑ Jones DM, Adams RJ, Berry JD,Brown TM et al. Heart disease and stroke statistics – 2011 update: a report from the American Heart Association. Circulation 2011; 123(4): e18– e209.

6. Kalita Z, Brabec P, Švancara J, Pavlovská L, Gaťková A,Ulč I. Vyhodnocení sběru epidemiologických dat u cévních mozkových příhod z registru IKTA za roky 2010 a 2011. I. Incidence cévních mozkových příhod v okrese Zlín. Ces Slov Neurol N 2013; 76/ 109(2): 183– 188.

7. Graham I, Atar D, Borch‑ Johnsen K, Boysen G, Burell G, Cifkova R et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2007; 28(19): 2375– 2414.

8. European Stroke Organisation (ESO) Executive Committee. ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25(5): 457– 507.

9. Cifková R, Škodová Z. Dlouhodobé trendy hlavních rizikových faktorů kardiovaskulárních onemocnění v české populaci. Cas Lek Cesk 2004; 143: 219– 226.

10. Rosamond W, Flegal K, Furie K, Go A, Greenlund K,Haase N et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117(4): e25– e146.

11. WHO MONICA Project Principal Investigators. The World Health Organization MONICA (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clin Epidemiol 1988; 41(2): 104– 114.

12. Kalita Z. Farmakologická sekundární prevence ischemické cévní mozkové příhody: mozkového infarktu/ tranzitorní ischemické ataky. Současnost a perspektivy. Med Prom 2010; 11 (Suppl 1): 24– 32.

13. Feigin VL,Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003, 2(1): 43–53.

14. Kalita Z. Farmakologická sekundární prevence nekardioembolického mozkovém infarktu/ ischemické tranzitorní ataky – současnost a budoucnost. Cesk Slov Neurol N 2011; 74/ 107(3): 261– 272.

15. Weimar C, Goertler M, Röther J, Ringelstein EB, Darius H, Nabavi DG et al. Systemic risk score evaluation in ischemic stroke patients (SCALA): a prospective cross sectional study in 85 German stroke units. J Neurol 2007; 254(11): 1562– 1568.

16. Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V. Assessment of cardiovascular risk by use of multiple‑ risk‑factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999; 100(13): 1481– 1492.

17. Graham I, Atar D, Borch‑ Johnsen K, Boysen G, Burell G, Cifkova R et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28(19): 2375– 2414.

18. Qureshi AL, Sapkota BL. Bloodreduction in secondary stroke prevention. Continuum 2011; 17: 1233– 1241.

19. Mancia G, Laurent S, Agabiti‑ Rosei E, Ambrosioni E,Burnier M, Caulfield MJ et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27(11): 2121– 2158.

20. Cifkova R, Skodova L, Bruthans J, Adamkova V, Jozifova M, Galovcova M et al. Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/ 8. Czech MONICA ad Czech post‑MONICA. Atherosclerosis 2010; 211(2): 676– 681.

21. Cifkova R, Skodova Z, Bruthans J, Holub J, Adamkova V, Jozifova M et al. Longitudinal trends in cardiovascular mortality and blood pressure levels, prevalence, awareness, treatment, and control of hypertension in Czech population from 1985 to 2007/ 2008. J Hypertens 2010; 28(11): 2196– 2203.

22. Puddey IB, Beilin LJ, Rakic V. Alcohol, hypertension and the cardiovascular system: a critical appraisal. Addiction Biol 1997; 2: 159– 170.

23. Roger VL, Go AS, Lloyd‑ Jones DM, Adams RJ, Berry JD, Brown TM et al. Heart disease and stroke statistics – 2011 update: a report from the American Heart Association. Circulation 2011; 123(4): e18– e209.

24. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25(5): 457– 507.

25. Vermeer SE, Sandee W, Algra A, Koudstaal PJ,Kappelle LJ, Dippel DW. Dutch TIA Trial Study Group. Impaired glucose tolerance increased stroke risk in nondiabetic patients with transient ischemic attack or minor ischemic stroke. Stroke 2006; 37(6): 1413– 1417.

26. ÚZIS ČR. Péče o nemocné s cukrovkou 2010. Dostuné na: http:/ / www.uzis.cz/ publikace/ pece‑ nemocne‑ cukrovkou‑ 2010.

27. Röther J, Alberts MJ, Touzé E, Mas JL, Hill MD,Michel P et al. Risk factor profile and management of cerebrovascular patients in the REACH Registry. Cerebrovasc Dis 2008; 25(4): 366– 374.

28. Grobbee DE, Koudstaal PJ, Bots ML, Amaducci LA,Elwood PC, Ferr J et al. Incidence and risk factors of ischaemic and haemorrhagic stroke in Europe. EUROSTROKE: A collaborative study among research centres in Europe: rationale and design. Neuroepidemiology 1996; 15(6): 291– 300.

29. Redon J, Olsen MH, Cooper RS, Zurriaga O, Martinez‑ Beneito MA, Laurent S et al. Stroke mortality and trends from 1990 to 2006 in countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J 2011; 32(11): 1424– 1431.

30. Kalita Z, Souček M, Sachová M. Výskyt rizikových faktorů cévních mozkových příhod v populaci České republiky. Prakt Lék 2003; 82: 643– 646.

31. Vytřískalová M. Adherence k medikamentózní léčbě – známá neznámá. Remedia 2009;19: 225– 230.

32. Bushnell CD, Olson DM, Zhao X, Pan W, Zimmer LO,Goldstein LB et al. Secondary preventive medication persistence and adherence 1 year after stroke. Neurology 2011; 77(12):