TY - JOUR
T1 - Suboptimal lipid management before and after ischaemic stroke and TIA—the North Dublin Population Stroke Study
AU - Ní Chróinín, Danielle
AU - Ní Chróinín, Chantelle
AU - Akijian, Layan
AU - Callaly, Elizabeth L.
AU - Hannon, Niamh
AU - Kelly, Lisa
AU - Marnane, Michael
AU - Merwick, Áine
AU - Sheehan, Órla
AU - Horgan, Gillian
AU - Duggan, Joseph
AU - Kyne, Lorraine
AU - Dolan, Eamon
AU - Murphy, Seán
AU - Williams, David
AU - Kelly, Peter J.
N1 - Funding Information:
Ethics approval was obtained from participating institutions and the Irish College of General Practitioners. Informed consent was obtained from patients or next-of-kin.
Publisher Copyright:
© 2018, Royal Academy of Medicine in Ireland.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Few population-based studies have assessed lipid adherence to international guidelines for primary and secondary prevention in stroke/transient ischaemic attack (TIA) patients. Aims: This study aims to evaluate adherence to lipid-lowering therapy (LLT) guidelines amongst patients with ischaemic stroke/TIA. Methods: Using hot and cold pursuit methods from multiple hospital/community sources, all stroke and TIA cases in North Dublin City were prospectively ascertained over a 1-year period. Adherence to National Cholesterol Education Programme (NCEP) III guidelines, before and after index ischaemic stroke/TIA, was assessed. Results: Amongst 616 patients (428 ischaemic stroke, 188 TIA), total cholesterol was measured following the qualifying event in 76.5% (471/616) and low-density lipoprotein (LDL) in 60.1% (370/616). At initial stroke/TIA presentation, 54.1% (200/370) met NCEP III LDL goals. Compliance was associated with prior stroke (odds ratio [OR] 2.19, p = 0.02), diabetes (OR 1.91, p = 0.04), hypertension (OR 1.57, p = 0.03), atrial fibrillation (OR 1.78, p = 0.01), pre-event LLT (OR 2.85, p < 0.001) and higher individual LDL goal (p = 0.001). At stroke/TIA onset, 32.7% (195/596) was on LLT. Nonetheless, LDL exceeded individual NCEP goal in 29.2% (56/192); 21.6% (53/245) warranting LLT was not on treatment prior to stroke/TIA onset. After index stroke/TIA, 75.9% (422/556) was on LLT; 15.3% (30/196) meeting NCEP III criteria was not prescribed a statin as recommended. By 2 years, actuarial survival was 72.8% and 11.9% (59/497) experienced stroke recurrence. No association was observed between initial post-event target adherence and 2-year outcomes. Conclusions: In this population-based study, LLT recommended by international guidelines was under-used, before and after index stroke/TIA. Strategies to improve adherence are needed.
AB - Background: Few population-based studies have assessed lipid adherence to international guidelines for primary and secondary prevention in stroke/transient ischaemic attack (TIA) patients. Aims: This study aims to evaluate adherence to lipid-lowering therapy (LLT) guidelines amongst patients with ischaemic stroke/TIA. Methods: Using hot and cold pursuit methods from multiple hospital/community sources, all stroke and TIA cases in North Dublin City were prospectively ascertained over a 1-year period. Adherence to National Cholesterol Education Programme (NCEP) III guidelines, before and after index ischaemic stroke/TIA, was assessed. Results: Amongst 616 patients (428 ischaemic stroke, 188 TIA), total cholesterol was measured following the qualifying event in 76.5% (471/616) and low-density lipoprotein (LDL) in 60.1% (370/616). At initial stroke/TIA presentation, 54.1% (200/370) met NCEP III LDL goals. Compliance was associated with prior stroke (odds ratio [OR] 2.19, p = 0.02), diabetes (OR 1.91, p = 0.04), hypertension (OR 1.57, p = 0.03), atrial fibrillation (OR 1.78, p = 0.01), pre-event LLT (OR 2.85, p < 0.001) and higher individual LDL goal (p = 0.001). At stroke/TIA onset, 32.7% (195/596) was on LLT. Nonetheless, LDL exceeded individual NCEP goal in 29.2% (56/192); 21.6% (53/245) warranting LLT was not on treatment prior to stroke/TIA onset. After index stroke/TIA, 75.9% (422/556) was on LLT; 15.3% (30/196) meeting NCEP III criteria was not prescribed a statin as recommended. By 2 years, actuarial survival was 72.8% and 11.9% (59/497) experienced stroke recurrence. No association was observed between initial post-event target adherence and 2-year outcomes. Conclusions: In this population-based study, LLT recommended by international guidelines was under-used, before and after index stroke/TIA. Strategies to improve adherence are needed.
KW - Compliance
KW - Hydroxymethylglutaryl-CoA reductase inhibitors
KW - Hyperlipidemia
KW - Lipids
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85040906100&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040906100&partnerID=8YFLogxK
U2 - 10.1007/s11845-018-1739-8
DO - 10.1007/s11845-018-1739-8
M3 - Article
C2 - 29368282
AN - SCOPUS:85040906100
SN - 0332-1029
VL - 187
SP - 739
EP - 746
JO - The Dublin Journal of Medical and Chemical Science
JF - The Dublin Journal of Medical and Chemical Science
IS - 3
ER -