Background and Aims
There is compelling evidence that >90% of ischemic strokes attribute to poor lifestyle and modifiable risk factors. In patients presenting with stroke/TIA, data on pre-event risk factor control and lifestyle are sparse. We analysed the frequency of inadequately treated risk conditions in patients with ischemic stroke or TIA and estimated the number of events potentially avertable by guideline-compliant preventive therapy in a large representative cohort.

Methods
A large prospective observational cohort of 1730 patients from the STROKE-CARD trial (NCT02156778) with acute ischaemic stroke or TIA (ABCD2-Score ≥3 points) were recruited between 2014 and 2017 at the study centre Innsbruck. We analyzed eight risk conditions amenable to drug therapy and three lifestyle risk behaviours in all patients regarding pre-event status.

Results
The mean number of inadequately treated risk conditions per patient was 1.36 and increased to 2.30 upon consideration of key lifestyle risk behaviours. Numbers were higher in patients with a recurrent stroke/TIA compared to first-ever events (1.59 vs. 1.30; p<0.001). Proportions of patients with at least one risk condition were 79.5% and 95.1% - lifestyle considered. The estimated degree of stroke preventability was high at 37.1% for risk conditions amenable to drug therapy and 32.4% for proper management of lifestyle risk behaviours.

Conclusion
Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. This gap applies to patients with first-ever events and even broadens in patients with recurrent stroke/TIA. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge to reduce the global burden of stroke.

ESOC-2019