Most Stroke Patients Have Undiagnosed Major Risk Factors

Results of a new study are underlining the need for prevention strategies and patient education, with data suggesting most patients with acute ischemic stroke had undiagnosed major vascular risk factors.

An analysis of data from more than 4300 stroke patients from a Swiss registry spanning more than a decade, results of the study indicates 67.7% of stroke patients had at least 1 or more undiagnosed major risk factors, with the most common among these being dyslipidemia and hypertension.

“Our findings underline the importance of testing and treating blood fat imbalances such as high cholesterol and triglyceride levels, as well as blood pressure and identifying and treating those with atrial fibrillation and type 2 diabetes”, said lead investigator André Rêgo, of the Lausanne University Hospital in Switzerland, in a statement.

Citing a lack of clinical information related to the frequency, patient profile, and stroke mechanisms of patients with acute ischemic stroke, Rêgo and a team of colleagues designed the current study with the intent of assessing the presence of undiagnosed major risk factors among patients with stroke within a single-center database. Named the Acute Stroke Registry and Analysis of Lausanne (ASTRAL), the registry provided investigators with information on all consecutive patients admitted to the Lausanne University Hospital from January 1, 2003, through December 31, 2018, with acute ischemic stroke presenting within 24 hours of symptom onset.

After exclusion of those who did not provide consent or were missing information related to demographic, clinical, therapeutic, and prognostic variables, investigators identified a cohort of 4354 patients for inclusion in their analyses. This cohort had a median age of 70 (IQR, 15.2) years and 44.7% were female. Investigators planned both univariate and multivariate logistic regression analysis to estimate the prevalence of risk factors and their associations with demographic, clinical, and therapeutic variables.

Upon analysis, investigators found 67.7% of patients had at least 1 undiagnosed major risk factor. Among those with undiagnosed major risk factors, the most common dyslipidemia (61.4%), hypertension (23.7%), atrial fibrillation (10.2%), diabetes mellitus (5.2%), an ejection fraction below 35% (2.0%), and coronary disease (1.0%). In multivariate analysis, results suggested lower age, non-Caucasian ethnicity, patent foramen ovale, contraceptive use among younger than 55 years of age, and smoking among those greater than 55 years of age were associated with increased likelihood of undiagnosed major risk factors.

However, investigators pointed out negative associations were observed for antiplatelet use before event and higher BMI.When assessing mechanisms, results indicated the cohort experienced a greater frequency of PFO-related stroke and lower frequency for large vessel, lacunar, cardiac, or stroke of multiple coexisting causes. Investigators also pointed out there were no differences in functional outcomes at 12 months and cerebrovascular recurrences based on presence of undiagnosed major risk factors.

“Prior to our study there was scarce clinical information about the frequency, patient profile and stroke mechanisms in patients with acute ischemic stroke with previously undiagnosed major vascular risk factors. We hope that this study will help to identify potential stroke patients that require more intensive prevention techniques and surveillance in the future,” Rêgo added.

This study, “Undiagnosed major risk factors in patients with acute ischaemic stroke: clinical profile, stroke mechanisms and outcome,” was presented at the European Academy of Neurology Congress 2022.