TY - JOUR
T1 - Risk Stratification in Patients with Ischemic Stroke and Residual Cardiovascular Risk with Current Secondary Prevention
AU - Gynnild, Mari Nordbø
AU - Hageman, Steven H.J.
AU - Dorresteijn, Jannick A.N.
AU - Spigset, Olav
AU - Lydersen, Stian
AU - Wethal, Torgeir
AU - Saltvedt, Ingvild
AU - Visseren, Frank L.J.
AU - Ellekjær, Hanne
N1 - Funding Information:
The Nor-COAST study was funded by the Norwegian Health Association and Norwegian University of Science and Technology (NTNU). The work of MNG was funded by Dam Foundation and the Liaison Committee between the Central Norway Regional Health Authority and NTNU.
Funding Information:
We gratefully acknowledge all participants, the NorCOAST research group and the dedicated study staff at participating hospitals. MMAS Research Morisky Widget Software US Copyright Office Number TX 8-816-517 is protected by US Copyright laws. Permission for use is required. A license agreement was made between St. Olav University Hospital and MMAS Research LLC. Funding The Nor-COAST study was funded by the Norwegian Health Association and Norwegian University of Science and Technology (NTNU). The work of MNG was funded by Dam Foundation and the Liaison Committee between the Central Norway Regional Health Authority and NTNU.
Publisher Copyright:
© 2021 Gynnild et al.
PY - 2021
Y1 - 2021
N2 - PURPOSE: Suboptimal secondary prevention in patients with stroke causes a remaining cardiovascular risk desirable to reduce. We have validated a prognostic model for secondary preventive settings and estimated future cardiovascular risk and theoretical benefit of reaching guideline recommended risk factor targets.PATIENTS AND METHODS: The SMART-REACH (Secondary Manifestations of Arterial Disease-Reduction of Atherothrombosis for Continued Health) model for 10-year and lifetime risk of cardiovascular events was applied to 465 patients in the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study, a multicenter observational study with two-year follow-up by linkage to national registries for cardiovascular disease and mortality. The residual risk when reaching recommended targets for blood pressure, low-density lipoprotein cholesterol, smoking cessation and antithrombotics was estimated.RESULTS: In total, 11.2% had a new event. Calibration plots showed adequate agreement between estimated and observed 2-year prognosis (C-statistics 0.63, 95% confidence interval 0.55-0.71). Median estimated 10-year risk of recurrent cardiovascular events was 42% (Interquartile range (IQR) 32-54%) and could be reduced to 32% by optimal guideline-based therapy. The corresponding numbers for lifetime risk were 70% (IQR 63-76%) and 61%. We estimated an overall median gain of 1.4 (IQR 0.2-3.4) event-free life years if guideline targets were met.CONCLUSION: Secondary prevention was suboptimal and residual risk remains elevated even after optimization according to current guidelines. Considerable interindividual variation in risk exists, with a corresponding variation in benefit from intensification of treatment. The SMART-REACH model can be used to identify patients with the largest benefit from more intensive treatment and follow-up.
AB - PURPOSE: Suboptimal secondary prevention in patients with stroke causes a remaining cardiovascular risk desirable to reduce. We have validated a prognostic model for secondary preventive settings and estimated future cardiovascular risk and theoretical benefit of reaching guideline recommended risk factor targets.PATIENTS AND METHODS: The SMART-REACH (Secondary Manifestations of Arterial Disease-Reduction of Atherothrombosis for Continued Health) model for 10-year and lifetime risk of cardiovascular events was applied to 465 patients in the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study, a multicenter observational study with two-year follow-up by linkage to national registries for cardiovascular disease and mortality. The residual risk when reaching recommended targets for blood pressure, low-density lipoprotein cholesterol, smoking cessation and antithrombotics was estimated.RESULTS: In total, 11.2% had a new event. Calibration plots showed adequate agreement between estimated and observed 2-year prognosis (C-statistics 0.63, 95% confidence interval 0.55-0.71). Median estimated 10-year risk of recurrent cardiovascular events was 42% (Interquartile range (IQR) 32-54%) and could be reduced to 32% by optimal guideline-based therapy. The corresponding numbers for lifetime risk were 70% (IQR 63-76%) and 61%. We estimated an overall median gain of 1.4 (IQR 0.2-3.4) event-free life years if guideline targets were met.CONCLUSION: Secondary prevention was suboptimal and residual risk remains elevated even after optimization according to current guidelines. Considerable interindividual variation in risk exists, with a corresponding variation in benefit from intensification of treatment. The SMART-REACH model can be used to identify patients with the largest benefit from more intensive treatment and follow-up.
KW - Cardiovascular diseases
KW - Ischemic stroke
KW - Risk assessment
KW - Risk factors
KW - Risks and benefits
KW - Secondary prevention
KW - risk assessment
KW - risks and benefits
KW - risk factors
KW - secondary prevention
KW - cardiovascular diseases
KW - ischemic stroke
UR - http://www.scopus.com/inward/record.url?scp=85117725037&partnerID=8YFLogxK
U2 - 10.2147/CLEP.S322779
DO - 10.2147/CLEP.S322779
M3 - Article
C2 - 34566434
AN - SCOPUS:85117725037
SN - 1179-1349
VL - 13
SP - 813
EP - 823
JO - Clinical Epidemiology
JF - Clinical Epidemiology
ER -