Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Stroke J. 2024 Mar;9(1):154-161. doi: 10.1177/23969873231215629. Epub 2023 Nov 30.
Long-term risk-factor control and secondary prevention are not well characterized in patients with a first transient ischemic attack (TIA). With baseline levels as reference, we compared primary-care data on blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and use of antihypertensives, statins and antiplatelet treatment/oral anticoagulation (APT/OAC) during 5 years after a first TIA.
Patients in QregPV, a Swedish primary-care register for the Region of Västra Götaland, with a first TIA discharge diagnosis from wards proficient in stroke care 2010 to 2012 were identified and followed up to 5 years. BP, LDL-C, smoking, use of antihypertensives, statins, APT/OAC, and achievement of target levels were calculated. We used logistic mixed-effect models to analyze the effect of follow-up over time on risk-factor control and secondary prevention treatment.
We identified 942 patients without prior cerebrovascular disease who had a first TIA. Compared to baseline, the first year of follow-up was associated with improvements in concomitant attainment of BP <140/90 mmHg, LDL-C < 2.6 mmol/L and non-smoking, which rose from 20% to 33% (OR 2.08, 95% CI 1.38-3.13), but then stagnated in years 2-5. In the first year of follow-up, 47% of patients had complete secondary prevention treatment (antihypertensives, APT/OAC and statin), but continued follow-up was associated with a yearly decrease in secondary prevention treatment (OR 0.94, 95% CI 0.94-0.98).
Risk-factor control was inadequate, leaving considerable potential for improved secondary prevention treatment after a first TIA in Swedish patients followed up to 5 years.
首次短暂性脑缺血发作（TIA）患者的长期风险因素控制和二级预防情况尚不清楚。以基线水平为参照，我们比较了首次 TIA 后 5 年内基层医疗保健数据中血压（BP）、低密度脂蛋白胆固醇（LDL-C）、吸烟以及使用降压药、他汀类药物和抗血小板治疗/口服抗凝剂（APT/OAC）的情况。
在瑞典哥德堡地区的 QregPV 初级保健注册中心中，我们识别出了 2010 年至 2012 年在擅长中风治疗的病房中首次 TIA 出院诊断的患者，并进行了长达 5 年的随访。计算了 BP、LDL-C、吸烟、降压药、他汀类药物、APT/OAC 的使用以及目标水平的达标情况。我们使用逻辑混合效应模型分析了随时间推移对风险因素控制和二级预防治疗的影响。
我们确定了 942 名无既往脑血管疾病的患者患有首次 TIA。与基线相比，首次随访年内，BP<140/90mmHg、LDL-C<2.6mmol/L 和不吸烟的同时达标率有所提高，从 20%上升至 33%（OR 2.08，95%CI 1.38-3.13），但随后在第 2-5 年停滞不前。在首次随访年内，47%的患者接受了完整的二级预防治疗（降压药、APT/OAC 和他汀类药物），但持续随访与二级预防治疗逐年减少相关（OR 0.94，95%CI 0.94-0.98）。
风险因素控制不足，在瑞典患者中，首次 TIA 后 5 年的二级预防治疗仍有很大的改进空间。
