Vascular risk factors after stroke in the elderly: a population-based study

Vascular risk factors after stroke in the elderly: a population-based study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Vascular risk factors after stroke in the elderly: a population-based study Maider Iza Achutegui, Federica Rizzo, Marta Olive-Gadea, Jordi Brunet, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7973410/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background The risk of recurrent stroke can be reduced by controlling modifiable risk factors such as hypertension, hypercholesterolemia, and diabetes. In this context, the aim of this study was to assess the level of control of these key factors in a representative cohort of stroke survivors residing in Catalonia, Spain. The analysis was conducted according to the current European Stroke Organisation (ESO) guidelines, with special emphasis on the elderly population. Methods An observational, retrospective, longitudinal study was conducted using data from the population-based database of the Health Quality and Assessment Agency of Catalonia. Patients diagnosed with ischemic stroke or transient ischemic attack (TIA) between 2014 and 2019 were included and followed for one year. Data were collected on blood pressure, cholesterol, and HbA1c levels, as well as on pharmacological treatment, including antithrombotic agents. A comparative analysis was performed across age groups, focusing particularly on elderly (> 67 years) and very elderly (> 87 years) stroke survivors. In total, 35,918 patients were included in the analysis. Results Of 35918 included patients, 54% were men and the median age was 77 years (IQR 68–88); 9336 (23%) were older than 87 years. During follow up, blood pressure data were available for 63% of patients. Among them, 49% of individuals aged 18–67 years and 42% of the very elderly achieved the target of < 130 mmHg. LDL-cholesterol levels were available for 5% of patients, with 31% of the younger group and 35% of the very elderly reaching the < 70 mg/dL target. Among patients with diabetes, HbA1c was assessed in 84%, and 81% of younger versus 83% of very elderly patients met the < 7% target. The prevalence of atrial fibrillation increased significantly with age; however, very elderly patients were less likely to receive oral anticoagulants (63% vs. 72–73%). Conclusion A substantial proportion of stroke survivors did not achieve the targets recommended by the ESO for secondary prevention. In the elderly population, fewer patients reached optimal blood pressure control, and anticoagulant use among those with atrial fibrillation was suboptimal. Efforts to improve risk factor management and adherence to guidelines are needed, with particular attention to older adults. Secondary prevention ischemic stroke vascular risk factor Figures Figure 1 Figure 2 Introduction With the aging of the population, cerebrovascular disease has become a leading cause of mortality, morbidity and a public healthcare problem worldwide. Ischemic stroke becomes more common with age due to various risk factors, and it is linked to a worse prognosis in older patients ( 1 , 2 ). Stroke survivors are at high risk of recurrent stroke: ranging from 9–15% during the first year and between 27–40% during the initial 10 years. In addition to non-modifiable risk factors such as age, there are modifiable risk factors such as hypertension, diabetes, and elevated cholesterol levels that are also associated with stroke and other cardiovascular events ( 3 ). The effective management of risk factors, by addressing modifiable factors, can significantly reduce the risk of recurrent stroke ( 3 , 4 ). High blood pressure is the main risk factor for stroke in most developed countries. Lowering blood pressure (BP) and low density lipoprotein (LDL) cholesterol levels is associated with a decreased risk of ischemic stroke risk, as well as other cardiovascular events ( 5 , 6 ). Moreover, patients that suffer from diabetes have twice the risk of having a stroke compared to those who are non-diabetic. In individuals with type 2 diabetes, a strong correlation has been identified between the risk of diabetic complications such as stroke and prior episodes of hyperglycemia. Any reduction in HbA1c levels is expected to significantly lower the likelihood of developing such complications ( 7 , 8 ). Antithrombotic treatment is the cornerstone of pharmacologic secondary stroke prevention. Use of antiplatelet therapy is recommended in patients with non-cardioembolic strokes, whereas oral anticoagulation therapy (OAC) reduces risk of recurrent strokes in those with atrial fibrillation ( 9 , 11 ). In 2022, ESO presented evidence-based guidelines that advocate for a blood pressure target < 130/80 mmHg, use of HMGCoA reductase inhibitors with a LDL-cholesterol target of 70mg/dl (< 1.8 mmol/l), and a target of HbA1c < 53mmol/ mol (7%, 154mg/dl) in diabetic patients ( 9 ). According to the Stroke Action Plan for Europe (SAP-E), secondary prevention is crucial for nearly all stroke and TIA patients, with the potential to reduce stroke recurrence by 80%. The minimum standard of care should include lifestyle advice, blood pressure management, antithrombotic therapy, statins, and carotid endarterectomy when needed ( 12 ). Despite all these evidenced-based recommendations, prior literature suggests that adherence to evidence-based guidelines for stroke care generally declines with increasing age ( 13 – 15 ). Additionally, age-related factors including the presence of multiple medical comorbidities, changes in the distribution and clearance of medications, and frailty, may substantially affect the effectiveness of both acute and chronic stroke treatments, as well as the overall recovery process ( 16 ). Aims We aim to describe the risk factor control and antithrombotic treatment according to ESO recommendations among stroke survivors in the Catalan population and to evaluate the impact of age in reaching these targets. Methods Study design We performed an observational retrospective longitudinal study. All data was retrospectively obtained from the PADRIS program (Data Analytics Program for research and innovation in health) from the Health Quality and Assessment Agency of Catalonia (AQuAS). Through International Classification Disease 9 and 10 codes, we selected patients who presented an ischemic stroke or TIA evaluated in 88 health centers in Catalunya during a 6-year period (2014–2019). Study population and data collection We identified 35918 subjects with an ischemic stroke or TIA, the first ischemic event was considered as the index stroke. Follow-up started on day 30 after the index event (therefore, patients who died at or before 30 days were omitted from the analysis) until day 365, and it was further divided in two periods: 30 to 180 and 180 to 360 days to evaluate trends in the early vs late follow-up periods. Figure 1 is a flow chart illustrating the information available at each period. We included baseline sociodemographic data (age, sex,), stroke diagnosis (ischemic stroke vs TIA) as well as clinical data (past stroke, hypertension, dyslipidemia, diabetes, atrial fibrillation, coronary heart disease, chronic kidney disease, congestive heart failure, chronic obstructive pulmonary disease, anemia, depressive-anxious disorder, regular enol consumption), prescription of antithrombotic agents, statins, antidiabetic or antihypertensive medication. We defined a contact with the healthcare system as any new record in the PADRIS database. In case of repeated measurements within a period, we computed the mean value for each subject. Follow-up data included the same clinical and prescription information as well as death, and Systolic and Diastolic BP (SBP and DBP) (mmHg), total cholesterol and LDL-cholesterol (mg/dl) and HbA1c (%). Furthermore, we conducted a thorough examination of the diverse risk factors, as well as the approaches to antithrombotic treatment and anticoagulation, with particular emphasis on the different age groups of the individuals. Missing data Considering the structure of the source of data, we differentiated two situations: 1) For longitudinal stable data (medical diagnosis and active drug prescriptions) we assumed that if information was missing in a period of interest (baseline, early or late follow-up), no changes had occurred since the last available record, and information was imputated accordingly. 2) For point data variable with time (such as vitals and laboratory tests) missing values in any period were quantified and reported as such. Descriptive analysis was performed using only available cases. Statistical analysis Categorical variables are reported as absolute values and percentages, and continuous variables, as mean and standard deviation (SD) or median and interquartile range. Between-group differences were assessed using a χ2 test (for categorical variables) and Student's t-test or ANOVA (for continuous variables, for comparison between 2 or > 2 groups). We obtained 95% confidence intervals using the exact binomial test. Level of significance was established at p 67) and very elderly (> 87) stroke survivors.All statistical analyses were performed using R (version 4.3.0, R Foundation for Statistical Computing, Vienna, Austria). Results Of the 35918 stroke survivors included in the analysis, 54% were men with a median age of 77 (IQR 68–88). Baseline demographic and clinical characteristics according to age groups are summarized in Table 1 . During the whole follow-up, 33906 (94%) individuals had at least one contact with the healthcare system. Data on BP was available in 63% of the individuals, mean SBP was 131(±14) mmHg and mean DBP 74 (±9) mmHg; 43% patients met the < 130mmHg recommendation (Fig. 2 ), and 68% of the patients received antihypertensive drugs. Data on total cholesterol was available for 59% of the patients but detailed cholesterol profile with LDL levels was recorded only in 5% of the individuals: mean LDL was 86.4 (±33.9) mg/dL, and 35% met < 70mg/dL recommendation (Fig. 2 ); 64% received statins. HbA1c was measured in 58% of the individuals, mean values were 5.95(±1.4) % and 81% met the < 7% target (Fig. 2 ); 29% received antidiabetic drugs. If we consider only patients with a previous diagnosis of diabetes, HbA1c was measured in 84% of patients, with a mean value of 7(±1.0) %; 57% of patients met < 7% target and 73% of the patients received antidiabetic drugs. See Table 2 and Fig. 2 for further analysis. Globally, 72% of the patients received antiplatelets or OAC: 62% of those without history of atrial fibrillation received antiplatelets and 69% of those with atrial fibrillation received OAC. Table 2 summarizes control of vascular risk factors and antithrombotic therapy in the early and late follow-up periods. Subgroup analysis: age All comparisons in SBP, LDL-cholesterol, HbA1c and antithrombotic therapy during the first year according to age subgroups are reported in Table 3 . Elderly patients (defined as those over 67 years of age) and very elderly patients (defined as those over 87 years of age) met the target of systolic blood pressure (SBP) < 130 mmHg in 41% and 42% of instances respectively, whereas this percentage was of 49% among younger patients (aged 18–67 years). Nevertheless, the percentage of individuals on antihypertensive medication rised with age, reaching 72% in the very eldery age group. Regarding cholesterol control, 35% of very elderly patients achieved adequate control, with LDL levels < 70 mg/dL, whereas this percentage was 31% among younger patients. Statin use showed an increasing trend in the middle-aged groups, reaching, reaching 71% in the elderly group, but then declined to 53% in the very elderly group. The proportion of individuals with HbA1c levels below 7% was higher in the very elderly group, reaching 83%. The use of antidiabetic treatment also increased with age, from 22% in the 18–67 age subgroup to 32% in the elderly group. The use of any form of antithrombotic treatment increased with age, reaching 74% in the very elderly group. The use of antiplatelet agents in patients without atrial fibrillation remained relatively stable, with a slight increase across age groups. The prevalence of atrial fibrillation rised significantly with age, from 10% in the 18–67 age group to 47% in the very elderly group. However, very elderly patients with a diagnosis of atrial fibrillation were less likely to receive OAC in comparison to the younger patienta (63% vs 73% respectively). Table 1 Baseline demographic and clinical characteristics according to age groups. 18–67 (N = 7124) 68–77 (N = 7900) 78–87 (N = 11558) 87–98 (N = 9336) p value Gender, Female, n (%) 2087 (29.3%) 2504 (31.7%) 5159 (44.6%) 6348 (68.0%) < 0.001 Transient ischemic attack/stroke, TIA, n (%) 1534 (21.5%) 1883 (23.8%) 2692 (23.3%) 1892 (20.3%) < 0.001 Hypertension, n (%) 4274 (60.0%) 6113 (77.4%) 9553 (82.7%) 7849 (84.1%) < 0.001 Diabetes mellitus, n (%) 1964 (27.6%) 3206 (40.6%) 5013 (43.4%) 3549 (38.0%) < 0.001 Dyslipidemia, n (%) 3784 (53.1%) 5227 (66.2%) 7745 (67.0%) 5472 (58.6%) < 0.001 Atrial fibrillation, n (%) 664 (9.3%) 1669 (21.1%) 3985 (34.5%) 4389 (47.0%) < 0.001 Coronary Artery disease, n (%) 811 (11.4%) 1336 (16.9%) 2170 (18.8%) 1567 (16.8%) < 0.001 Congestive Heart failure, n (%) 453 (6.4%) 912 (11.5%) 2145 (18.6%) 2731 (29.3%) < 0.001 Chronic kidney disease, n (%) 418 (5.9%) 1017 (12.9%) 2629 (22.7%) 2975 (31.9%) < 0.001 Smoker, n (%) 4935 (69.3%) 4211 (53.3%) 4053 (35.1%) 1487 (15.9%) < 0.001 Regular alcohol consumption, n (%) 1559 (21.9%) 1449 (18.3%) 1127 (9.8%) 305 (3.3%) < 0.001 Mixed-ansiety depressive disorder, n (%) 1349 (18.9%) 1395 (17.7%) 2276 (19.7%) 1902 (20.4%) < 0.001 Antiplatelet therapy, n (%) 3760 (54.8%) 3976 (51.8%) 5470 (48.6%) 4169 (46.2%) < 0.001 Anticoagulation therapy n (%) 780 (11.4%) 1203 (15.7%) 2505 (22.3%) 2290 (25.4%) < 0.001 Table 2 Follow-up data on vascular risk factor control during 1–6 and 6–12 months after index event. 1–6 months (N = 35918) 6–12 months (N = 34524) Systolic Blood Pressure, mmHg Available records, n (%) 17871 (50) 14451 (42) Mean (± SD) 131.3 (± 14.9) 131.6 (± 14.6) SBP < 130 mmHg, median (IQR) 43 (42–44) 41 (41–42) Antihypertensive therapy 67 (67–68) 68 (67–68) LDL-cholesterol, mg/ml Available records, n (%) 1080 ( 3 ) 870 ( 3 ) Mean (± SD) 86.3 (± 32.4) 86.5 (± 35.4) LDL < 70 mg/dl 33 (31–36) 36 (32–39) Statins 65 (64–65) 65 (64–65) HBA1c, % Available records, n (%) 19581 (56) 17503 (51) Mean (± SD) 6.0 (± 1.4) 5.9 (± 1.4) HBA1c < 7% 81 (81–82) 81 (81–82) Antidiabetic drugs 28 ( 28 – 29 ) 29 ( 28 – 29 ) Antithrombotic therapy Prescription of any antithrombotic 65 (64–65) 73 (72–73) Antiplatelets 48 (47–48) 53 (52–53) Antiplatelets excluding subjects with atrial fibrillation 54 (54–55) 61 (61–62) Oral anticoagulants 21 ( 20 – 21 ) 24 ( 24 – 25 ) Atrial fibrillation 65 (64–66) 71 (70–72) All results are expressed as percentages and their 95% confidence interval, unless otherwise specified. SD, standard deviation; CI, confidence interval; SBP, systolic blood pressure; DBP, diastoliclood pressure Table 3 Risk factor control and compliance according to age-groups during the first 12 months after index event. Age group 18–67 (N = 7124) 68–77 (N = 7900) 78–87 (N = 11558) 88–98 (N = 9336) p value Systolic Blood Pressure, mmHg Available records, n(%) 4344 (61) 5247 (66) 7659 (66) 5405 (58) < 0.001 Mean (± SD) 129(± 14) 132 (± 15) 132 (± 14) 132 (± 15) < 0.001 < 130 mmHg 49 (48–51) 41 (39–42) 41 (40–42) 42 (41–43) < 0.001 Antihypertensives 55 (53–56) 68 (67–69) 72 (71–73) 72 (71–73) < 0.001 LDL-cholesterol, mg/ml Available records, n(%) 485 ( 7 ) 458 ( 6 ) 567 ( 5 ) 253 ( 3 ) < 0.001 Mean (± SD) 90 (± 35) 84 (± 29) 86 (± 34) 88 (± 34) 0.174 < 70 mg/dl 31 ( 27 – 35 ) 33 (29–38) 35 (32–39) 35 (30–41) 0.461 Statins 67 (66–68) 71 (70–72) 66 (65–67) 53 (52–54) < 0.001 HBA1c, % Available records, n(%) 3750 (53) 4962 (63) 7278 (63) 4938 (53) < 0.001 Mean (± SD) 5.9 (± 1.5) 6.0 (± 1.4) 6.0 (± 1.3) 5.9 (± 1.3) < 0.001 < 7% 81 (80–82) 80 (79–81) 82 (81–83) 83 (82–84) < 0.001 Antidiabetic 22 ( 21 – 23 ) 32 ( 31 – 33 ) 33 ( 32 – 34 ) 26 (27 − 25) < 0.001 Antithrombotic therapy Any antithrombotic 68 (67–69) 71 (70–72) 75 (74–76) 74 (73–75) < 0.001 Atrial fibrillation, n(%) 630 ( 10 ) 1593 ( 21 ) 3829 ( 35 ) 4072 (47) < 0.001 Antiplatelets in patients without atrial fibrillation 60 (59–61) 62 (61–63) 64 (63–65) 61 (60–62) < 0.001 Anticoagulants in patients with atrial fibrillation 73 (70–77) 73 (71–75) 72 (71–74) 63 (62–65) < 0.001 All results are expressed as percentages and their 95% confidence interval, unless otherwise specified Discussion In this cohort of stroke and transient ischemic attack (TIA) survivors in the Catalonia region, we found that a substantial proportion of patients lacked a comprehensive assessment of vascular risk factors during the first year after an ischemic stroke, even though most patients had at least one contact with healthcare services during this period. Moreover, among those patients with available follow-up data on vascular risk factors, the majority did not achieve the recommended guideline targets. Comparable levels of suboptimal risk factor control have been reported in previous studies involving cohorts of patients with acute stroke and acute coronary syndromes. In a prospective cohort study conducted in Norway by Gynnild et al. ( 17 ), patients were followed for 18 months after an ischemic stroke, and it was found that only 41–47% achieved the recommended blood pressure target of < 140/90 mmHg, while approximately half met the LDL-cholesterol goal of < 2 mmol/L (77 mg/dL). Similarly, in a european registry of patients with coronary heart disease, just 58% of patients attained adequate blood pressure control; a mere 29% reached LDL-cholesterol levels below 70 mg/dL, and 54% of diabetic patients maintained HbA1c levels under 7% ( 18 ). When assessing these risk factors and the treatments received according to the age group, a clear trend emerges, showing an increased use of antihypertensive, antidiabetic, and antithrombotic therapies with advancing age, presumably in alignment with the higher comorbidities observed in these patients. Despite the higher medication use in older populations, control of certain risk factors, such as blood pressure, becomes poorer with age. Furthermore, the monitoring of critical cardiovascular parameters, particularly blood pressure, was less frequent in the very elderly. This may be due to the fact that current guidelines suggest that some risk factor targets could be tailored to the patient’s characteristics. For example, some reports propose that a less restrictive SBP target might be recommended for older patients, especially those with cognitive impairment ( 9 , 19 ). Nevertheless, recent studies suggest that even frail patients benefit from intensive blood pressure control, with frail patients being predominantly those categorized as elderly or very elderly ( 20 ). Moreover, several studies have provided evidence indicating a reduction in stroke risk among older patients following antihypertensive treatment ( 21 , 22 ). This would involve not only antihypertensive medication but also the implementation of appropriate lifestyle modifications, including physical exercise and smoking cessation ( 23 , 24 ). These measures are of particular significance in the elderly population, as they are more prone to a sedentary lifestyle ( 25 ). Furthermore, very elderly patients, received fewer statins compared to other patient subgroups. This is of particular importance, as it has been established that statins offer significant benefits in reducing stroke risk in the elderly population ( 26 ). Additionally, alternative lipid-lowering treatments have not been shown to confer a comparable reduction in stroke risk as statins, and as such, they are not currently endorsed as first-line therapeutic options ( 27 ). With respect to the use of antithrombotic agents in secondary stroke prevention, it is necessary to underline the low prescription rates of antithrombotic drugs, especially in the first months after stroke: only 72% of patients were prescribed with antiplatelet therapy during the first year, with similar rates between age subgroups. In this context, a cohort study from Switzerland, reported that as many as 20% of patients with a recurrent history of ischemic stroke/TIA were not receiving antithrombotic therapy at the time of their recurrence ( 28 ). Conversely, among patients with atrial fibrillation, anticoagulation rates in our series were higher than those documented in a systematic review of patients with atrial fibrillation and high stroke risk ( 29 ). We hypothesize that the widespread use of direct oral anticoagulants (DOACs) may have contributed to the increased rate of anticoagulant therapy over the past decade. However, this increase could also be explained by the fact that our analysis focused on secondary prevention, and the previous reported study included primary and secondary prevention. Nevertheless, even though atrial fibrillation becomes more common with age, we found a trend towards a lower prescription of OAC in the elderly group. These findings are consistent with previous literature ( 30 , 31 ). Nonetheless, as people age, the overall benefit of oral anticoagulation (OAC) grows, as it helps reduce the increasing stroke risk while weighing against the risk of severe bleeding ( 30 ). Thus, use of OAC in elderly and very elderly should be encouraged. Regarding the study's design and scope, this study has several advantages, as well as limitations due to to its design. On the one hand, PADRIS database includes data from the Catalan public health system, and follow-up from private healthcare providers is not included. However, only 32% of habitants in the region have an additional private insurance, and the percentage decreases to 21% for people aged 65 or older ( 32 ). Finally, other important variables like compliance with prescribed medical therapy, physical activity, or smoking habits were missing (history of smoking was recorded, but not smoke cessation). Additionally, it is important to emphasize that the relationship between risk factor control and stroke recurrence has not been addressed. Nevertheless, we have already studied this issue in a separate publication ( 33 ). On the other hand, this study has the advantage of providing insight into real-world management of follow-up after an ischemic stroke. Additionally, the large sample size enhances the statistical power and generalizability of the findings to the broader population of stroke survivors. The use of routinely collected data from a comprehensive regional health database allows for an accurate reflection of everyday clinical practice. Furthermore, longitudinal follow-up facilitates the evaluation of treatment patterns and risk factor control over time, while the inclusion of diverse age groups, including elderly and very elderly patients, provides important information on age-related differences in secondary prevention. In conclusion, improving the management of vascular risk factors is crucial for effectively reducing the recurrence of stroke and major cardiovascular events among stroke survivors. Nevertheless, this management was found to be suboptimal after hospital discharge. Furthermore, in elderly patients, we observed a noticeable trend towards under-treatment of atrial fibrillation as well as a poor control of certain risk factors such as blood pressure. This highlights a potential gap in the management of stroke prevention within this age subgroup. To address this, several initiatives in our region have been implemented to improve communication between patients and medical professionals as well as among different levels of healthcare providers ( 34 , 35 ). Future studies should determine if an improved communication with primary care providers leads to a more rigorous control in secondary prevention and improved outcomes. Declarations Declaration of competing interests Drs Ribo and Molina are cofounders and hold stock from Nora. Dr Colangelo is the CTO of NoraHealth. Dr Ribo holds stocks from Anaconda Biomed and reported receiving personal fees from AptaTargets, Cerenovus, Medtronic, Methinks, Philips, and Stryker outside the submitted work. Dr Rubiera reported compensation from Bayer for data and safety monitoring services outside the present work. The other authors report no conflicts Funding PRERISK project was supported by Fundación Instituto Carlos III under grant PI20/01768, by Ministerio de Asuntos Económicos y Transformación Digital under grant MIA.2021.M02.0005, and by the European Commission under the Horizon Europe grant 101057263 Guarantor MO Authors´Contributions MI, MO and MRu conceived and participated in the design of this study. FR, GC and DD were involved in patient recruitment and data analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript. Ethical approval and consent to participate The study received approval from the local ethical committee (PR(AG)107/2020). All participants provided informed consent to participate in the study. Informed consent As this is a registry study the medical ethics committee waived the need for obtaining informed consent. 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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Forcadell Drago E, Rodríguez Cumplido D, et al. Gender and Socioeconomic Inequality in the Prescription of Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation in Primary Care in Catalonia (Fantas-TIC Study). Int J Environ Res Public Health. 2021;18(20):10993. 10.3390/ijerph182010993 . Colangelo G, Ribo M, Montiel E, Dominguez D, Olivé-Gadea M, Muchada M, et al. PRERISK: A Personalized, Artificial Intelligence-Based and Statistically-Based Stroke Recurrence Predictor for Recurrent Stroke. Stroke. 2024;55(5):1200–9. 10.1161/STROKEAHA.123.043691 . Requena M, Montiel E, Baladas M, Muchada M, Boned S, López R, et al. Farmalarm Stroke. 2019;50(7):1819–24. 10.1161/STROKEAHA.118.024355 . Harmonics [Internet]. [cited 2024 Apr 2]. Available from: https://harmonicsproject.eu. Additional Declarations Competing interest reported. Drs Ribo and Molina are cofounders and hold stock from Nora. Dr Colangelo is the CTO of NoraHealth. Dr Ribo holds stocks from Anaconda Biomed and reported receiving personal fees from AptaTargets, Cerenovus, Medtronic, Methinks, Philips, and Stryker outside the submitted work. Dr Rubiera reported compensation from Bayer for data and safety monitoring services outside the present work. The other authors report no conflicts Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 18 May, 2026 Reviews received at journal 29 Nov, 2025 Reviewers agreed at journal 28 Nov, 2025 Reviewers invited by journal 28 Nov, 2025 Editor invited by journal 04 Nov, 2025 Editor assigned by journal 03 Nov, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 28 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:53:07","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131507,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7973410/v1/94630376692b23d1712b0663.html"},{"id":97269472,"identity":"78b118a0-7056-4bf7-8d52-c6f5b1bc6e0d","added_by":"auto","created_at":"2025-12-02 14:53:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74511,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart representing the number of patients included and contacts with healthcare providers at each timepoint.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7973410/v1/ac4dbd8b8081db4f4ce81e53.png"},{"id":97269471,"identity":"185c7df6-368f-42fa-aecb-dc68d9ae09d9","added_by":"auto","created_at":"2025-12-02 14:53:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35030,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of patients with available records and compliance with ESO targets.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7973410/v1/220bb2bf3893de66cf3487ab.png"},{"id":97664617,"identity":"ac969d17-8297-4b31-9ee1-646689af86f0","added_by":"auto","created_at":"2025-12-08 09:11:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1186752,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7973410/v1/fac99b67-b902-4bb4-a844-5a3ce0f7db17.pdf"}],"financialInterests":"Competing interest reported. Drs Ribo and Molina are cofounders and hold stock from Nora. Dr Colangelo is the CTO of NoraHealth. Dr Ribo holds stocks from Anaconda Biomed and reported receiving personal fees from AptaTargets, Cerenovus, Medtronic, Methinks, Philips, and Stryker outside the submitted work. Dr Rubiera reported compensation from Bayer for data and safety monitoring services outside the present work. The other authors report no conflicts","formattedTitle":"Vascular risk factors after stroke in the elderly: a population-based study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging of the population, cerebrovascular disease has become a leading cause of mortality, morbidity and a public healthcare problem worldwide. Ischemic stroke becomes more common with age due to various risk factors, and it is linked to a worse prognosis in older patients (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Stroke survivors are at high risk of recurrent stroke: ranging from 9\u0026ndash;15% during the first year and between 27\u0026ndash;40% during the initial 10 years. In addition to non-modifiable risk factors such as age, there are modifiable risk factors such as hypertension, diabetes, and elevated cholesterol levels that are also associated with stroke and other cardiovascular events (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The effective management of risk factors, by addressing modifiable factors, can significantly reduce the risk of recurrent stroke (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHigh blood pressure is the main risk factor for stroke in most developed countries. Lowering blood pressure (BP) and low density lipoprotein (LDL) cholesterol levels is associated with a decreased risk of ischemic stroke risk, as well as other cardiovascular events (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Moreover, patients that suffer from diabetes have twice the risk of having a stroke compared to those who are non-diabetic. In individuals with type 2 diabetes, a strong correlation has been identified between the risk of diabetic complications such as stroke and prior episodes of hyperglycemia. Any reduction in HbA1c levels is expected to significantly lower the likelihood of developing such complications (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAntithrombotic treatment is the cornerstone of pharmacologic secondary stroke prevention. Use of antiplatelet therapy is recommended in patients with non-cardioembolic strokes, whereas oral anticoagulation therapy (OAC) reduces risk of recurrent strokes in those with atrial fibrillation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2022, ESO presented evidence-based guidelines that advocate for a blood pressure target\u0026thinsp;\u0026lt;\u0026thinsp;130/80 mmHg, use of HMGCoA reductase inhibitors with a LDL-cholesterol target of 70mg/dl (\u0026lt;\u0026thinsp;1.8 mmol/l), and a target of HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;53mmol/ mol (7%, 154mg/dl) in diabetic patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the Stroke Action Plan for Europe (SAP-E), secondary prevention is crucial for nearly all stroke and TIA patients, with the potential to reduce stroke recurrence by 80%. The minimum standard of care should include lifestyle advice, blood pressure management, antithrombotic therapy, statins, and carotid endarterectomy when needed (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite all these evidenced-based recommendations, prior literature suggests that adherence to evidence-based guidelines for stroke care generally declines with increasing age (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Additionally, age-related factors including the presence of multiple medical comorbidities, changes in the distribution and clearance of medications, and frailty, may substantially affect the effectiveness of both acute and chronic stroke treatments, as well as the overall recovery process (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAims\u003c/h3\u003e\n\u003cp\u003e We aim to describe the risk factor control and antithrombotic treatment according to ESO recommendations among stroke survivors in the Catalan population and to evaluate the impact of age in reaching these targets.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eWe performed an observational retrospective longitudinal study. All data was retrospectively obtained from the PADRIS program (Data Analytics Program for research and innovation in health) from the Health Quality and Assessment Agency of Catalonia (AQuAS). Through International Classification Disease 9 and 10 codes, we selected patients who presented an ischemic stroke or TIA evaluated in 88 health centers in Catalunya during a 6-year period (2014–2019).\u003c/p\u003e\n\u003ch3\u003eStudy population and data collection\u003c/h3\u003e\n\u003cp\u003eWe identified 35918 subjects with an ischemic stroke or TIA, the first ischemic event was considered as the index stroke. Follow-up started on day 30 after the index event (therefore, patients who died at or before 30 days were omitted from the analysis) until day 365, and it was further divided in two periods: 30 to 180 and 180 to 360 days to evaluate trends in the early vs late follow-up periods. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e is a flow chart illustrating the information available at each period.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWe included baseline sociodemographic data (age, sex,), stroke diagnosis (ischemic stroke vs TIA) as well as clinical data (past stroke, hypertension, dyslipidemia, diabetes, atrial fibrillation, coronary heart disease, chronic kidney disease, congestive heart failure, chronic obstructive pulmonary disease, anemia, depressive-anxious disorder, regular enol consumption), prescription of antithrombotic agents, statins, antidiabetic or antihypertensive medication.\u003c/p\u003e\u003cp\u003eWe defined a contact with the healthcare system as any new record in the PADRIS database. In case of repeated measurements within a period, we computed the mean value for each subject.\u003c/p\u003e\u003cp\u003eFollow-up data included the same clinical and prescription information as well as death, and Systolic and Diastolic BP (SBP and DBP) (mmHg), total cholesterol and LDL-cholesterol (mg/dl) and HbA1c (%). Furthermore, we conducted a thorough examination of the diverse risk factors, as well as the approaches to antithrombotic treatment and anticoagulation, with particular emphasis on the different age groups of the individuals.\u003c/p\u003e\n\u003ch3\u003eMissing data\u003c/h3\u003e\n\u003cp\u003eConsidering the structure of the source of data, we differentiated two situations: 1) For longitudinal stable data (medical diagnosis and active drug prescriptions) we assumed that if information was missing in a period of interest (baseline, early or late follow-up), no changes had occurred since the last available record, and information was imputated accordingly. 2) For point data variable with time (such as vitals and laboratory tests) missing values in any period were quantified and reported as such. Descriptive analysis was performed using only available cases.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eCategorical variables are reported as absolute values and percentages, and continuous variables, as mean and standard deviation (SD) or median and interquartile range. Between-group differences were assessed using a χ2 test (for categorical variables) and Student's t-test or ANOVA (for continuous variables, for comparison between 2 or \u0026gt;\u0026thinsp;2 groups). We obtained 95% confidence intervals using the exact binomial test. Level of significance was established at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. A comparison of different age-groups was performed, focusing on elderly (\u0026gt;\u0026thinsp;67) and very elderly (\u0026gt;\u0026thinsp;87) stroke survivors.All statistical analyses were performed using R (version 4.3.0, R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 35918 stroke survivors included in the analysis, 54% were men with a median age of 77 (IQR 68\u0026ndash;88). Baseline demographic and clinical characteristics according to age groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eDuring the whole follow-up, 33906 (94%) individuals had at least one contact with the healthcare system. Data on BP was available in 63% of the individuals, mean SBP was 131(\u0026plusmn;14) mmHg and mean DBP 74 (\u0026plusmn;9) mmHg; 43% patients met the \u0026lt;\u0026thinsp;130mmHg recommendation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and 68% of the patients received antihypertensive drugs. Data on total cholesterol was available for 59% of the patients but detailed cholesterol profile with LDL levels was recorded only in 5% of the individuals: mean LDL was 86.4 (\u0026plusmn;33.9) mg/dL, and 35% met\u0026thinsp;\u0026lt;\u0026thinsp;70mg/dL recommendation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e); 64% received statins. HbA1c was measured in 58% of the individuals, mean values were 5.95(\u0026plusmn;1.4) % and 81% met the \u0026lt;\u0026thinsp;7% target (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e); 29% received antidiabetic drugs. If we consider only patients with a previous diagnosis of diabetes, HbA1c was measured in 84% of patients, with a mean value of 7(\u0026plusmn;1.0) %; 57% of patients met\u0026thinsp;\u0026lt;\u0026thinsp;7% target and 73% of the patients received antidiabetic drugs. See Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for further analysis.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eGlobally, 72% of the patients received antiplatelets or OAC: 62% of those without history of atrial fibrillation received antiplatelets and 69% of those with atrial fibrillation received OAC. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes control of vascular risk factors and antithrombotic therapy in the early and late follow-up periods.\u003c/p\u003e\n\u003ch3\u003eSubgroup analysis: age\u003c/h3\u003e\n\u003cp\u003eAll comparisons in SBP, LDL-cholesterol, HbA1c and antithrombotic therapy during the first year according to age subgroups are reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Elderly patients (defined as those over 67 years of age) and very elderly patients (defined as those over 87 years of age) met the target of systolic blood pressure (SBP)\u0026thinsp;\u0026lt;\u0026thinsp;130 mmHg in 41% and 42% of instances respectively, whereas this percentage was of 49% among younger patients (aged 18\u0026ndash;67 years). Nevertheless, the percentage of individuals on antihypertensive medication rised with age, reaching 72% in the very eldery age group. Regarding cholesterol control, 35% of very elderly patients achieved adequate control, with LDL levels\u0026thinsp;\u0026lt;\u0026thinsp;70 mg/dL, whereas this percentage was 31% among younger patients. Statin use showed an increasing trend in the middle-aged groups, reaching, reaching 71% in the elderly group, but then declined to 53% in the very elderly group. The proportion of individuals with HbA1c levels below 7% was higher in the very elderly group, reaching 83%. The use of antidiabetic treatment also increased with age, from 22% in the 18\u0026ndash;67 age subgroup to 32% in the elderly group.\u003c/p\u003e\u003cp\u003eThe use of any form of antithrombotic treatment increased with age, reaching 74% in the very elderly group. The use of antiplatelet agents in patients without atrial fibrillation remained relatively stable, with a slight increase across age groups. The prevalence of atrial fibrillation rised significantly with age, from 10% in the 18\u0026ndash;67 age group to 47% in the very elderly group. However, very elderly patients with a diagnosis of atrial fibrillation were less likely to receive OAC in comparison to the younger patienta (63% vs 73% respectively).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline demographic and clinical characteristics according to age groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;67 (N\u0026thinsp;=\u0026thinsp;7124)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68\u0026ndash;77 (N\u0026thinsp;=\u0026thinsp;7900)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u0026ndash;87 (N\u0026thinsp;=\u0026thinsp;11558)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87\u0026ndash;98 (N\u0026thinsp;=\u0026thinsp;9336)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender, Female, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2087 (29.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2504 (31.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5159 (44.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6348 (68.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTransient ischemic attack/stroke, TIA, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1534 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1883 (23.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2692 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1892 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4274 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6113 (77.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9553 (82.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7849 (84.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes mellitus, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1964 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3206 (40.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5013 (43.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3549 (38.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDyslipidemia, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3784 (53.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5227 (66.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7745 (67.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5472 (58.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAtrial fibrillation, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e664 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1669 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3985 (34.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4389 (47.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoronary Artery disease, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e811 (11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1336 (16.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2170 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1567 (16.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCongestive Heart failure, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e453 (6.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e912 (11.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2145 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2731 (29.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic kidney disease, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e418 (5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1017 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2629 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2975 (31.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoker, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4935 (69.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4211 (53.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4053 (35.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1487 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegular alcohol consumption, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1559 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1449 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1127 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e305 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMixed-ansiety depressive disorder, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1349 (18.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1395 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2276 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1902 (20.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntiplatelet therapy, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3760 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3976 (51.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5470 (48.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4169 (46.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnticoagulation therapy n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e780\u003c/p\u003e\u003cp\u003e(11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1203 (15.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2505 (22.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2290\u003c/p\u003e\u003cp\u003e(25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFollow-up data on vascular risk factor control during 1\u0026ndash;6 and 6\u0026ndash;12 months after index event.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;6 months\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;35918)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;34524)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSystolic Blood Pressure, mmHg\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17871 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14451 (42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131.3 (\u0026plusmn;\u0026thinsp;14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131.6 (\u0026plusmn;\u0026thinsp;14.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP\u0026thinsp;\u0026lt;\u0026thinsp;130 mmHg, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (42\u0026ndash;44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (41\u0026ndash;42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensive therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (67\u0026ndash;68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (67\u0026ndash;68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLDL-cholesterol, mg/ml\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1080 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e870 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86.3 (\u0026plusmn;\u0026thinsp;32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.5 (\u0026plusmn;\u0026thinsp;35.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL\u0026thinsp;\u0026lt;\u0026thinsp;70 mg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (31\u0026ndash;36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (32\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (64\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (64\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHBA1c, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19581 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17503 (51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0 (\u0026plusmn;\u0026thinsp;1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.9 (\u0026plusmn;\u0026thinsp;1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHBA1c\u0026thinsp;\u0026lt;\u0026thinsp;7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (81\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (81\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntidiabetic drugs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntithrombotic therapy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrescription of any antithrombotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (64\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (72\u0026ndash;73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiplatelets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (47\u0026ndash;48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (52\u0026ndash;53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiplatelets excluding subjects with atrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (54\u0026ndash;55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (61\u0026ndash;62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOral anticoagulants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (64\u0026ndash;66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (70\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll results are expressed as percentages and their 95% confidence interval, unless otherwise specified. SD, standard deviation; CI, confidence interval; SBP, systolic blood pressure; DBP, diastoliclood pressure\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk factor control and compliance according to age-groups during the first 12 months after index event.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;67 (N\u0026thinsp;=\u0026thinsp;7124)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68\u0026ndash;77 (N\u0026thinsp;=\u0026thinsp;7900)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u0026ndash;87 (N\u0026thinsp;=\u0026thinsp;11558)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88\u0026ndash;98 (N\u0026thinsp;=\u0026thinsp;9336)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eSystolic Blood Pressure, mmHg\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4344 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5247 (66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7659 (66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5405 (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129(\u0026plusmn;\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (\u0026plusmn;\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e132 (\u0026plusmn;\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e132 (\u0026plusmn;\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;130 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (48\u0026ndash;51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (39\u0026ndash;42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (40\u0026ndash;42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42 (41\u0026ndash;43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (53\u0026ndash;56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (67\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (71\u0026ndash;73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (71\u0026ndash;73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLDL-cholesterol, mg/ml\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e485 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e458 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e567 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e253 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (\u0026plusmn;\u0026thinsp;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (\u0026plusmn;\u0026thinsp;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (\u0026plusmn;\u0026thinsp;34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88 (\u0026plusmn;\u0026thinsp;34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;70 mg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (\u003cspan additionalcitationids=\"CR28 CR29 CR30 CR31 CR32 CR33 CR34\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (29\u0026ndash;38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (32\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35 (30\u0026ndash;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (66\u0026ndash;68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (70\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66 (65\u0026ndash;67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53 (52\u0026ndash;54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHBA1c, %\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvailable records, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3750 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4962 (63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7278 (63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4938 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.9 (\u0026plusmn;\u0026thinsp;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0 (\u0026plusmn;\u0026thinsp;1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.0 (\u0026plusmn;\u0026thinsp;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.9 (\u0026plusmn;\u0026thinsp;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (80\u0026ndash;82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (79\u0026ndash;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (81\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83 (82\u0026ndash;84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntidiabetic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (27\u0026thinsp;\u0026minus;\u0026thinsp;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAntithrombotic therapy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny antithrombotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (67\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (70\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (74\u0026ndash;76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74 (73\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial fibrillation, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e630 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1593 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3829 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4072 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiplatelets in patients without atrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (59\u0026ndash;61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (61\u0026ndash;63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (63\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e61 (60\u0026ndash;62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnticoagulants in patients with atrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (70\u0026ndash;77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (71\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (71\u0026ndash;74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63 (62\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll results are expressed as percentages and their 95% confidence interval, unless otherwise specified\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this cohort of stroke and transient ischemic attack (TIA) survivors in the Catalonia region, we found that a substantial proportion of patients lacked a comprehensive assessment of vascular risk factors during the first year after an ischemic stroke, even though most patients had at least one contact with healthcare services during this period.\u003c/p\u003e\u003cp\u003e Moreover, among those patients with available follow-up data on vascular risk factors, the majority did not achieve the recommended guideline targets. Comparable levels of suboptimal risk factor control have been reported in previous studies involving cohorts of patients with acute stroke and acute coronary syndromes. In a prospective cohort study conducted in Norway by Gynnild et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), patients were followed for 18 months after an ischemic stroke, and it was found that only 41\u0026ndash;47% achieved the recommended blood pressure target of \u0026lt;\u0026thinsp;140/90 mmHg, while approximately half met the LDL-cholesterol goal of \u0026lt;\u0026thinsp;2 mmol/L (77 mg/dL). Similarly, in a european registry of patients with coronary heart disease, just 58% of patients attained adequate blood pressure control; a mere 29% reached LDL-cholesterol levels below 70 mg/dL, and 54% of diabetic patients maintained HbA1c levels under 7% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen assessing these risk factors and the treatments received according to the age group, a clear trend emerges, showing an increased use of antihypertensive, antidiabetic, and antithrombotic therapies with advancing age, presumably in alignment with the higher comorbidities observed in these patients. Despite the higher medication use in older populations, control of certain risk factors, such as blood pressure, becomes poorer with age. Furthermore, the monitoring of critical cardiovascular parameters, particularly blood pressure, was less frequent in the very elderly. This may be due to the fact that current guidelines suggest that some risk factor targets could be tailored to the patient\u0026rsquo;s characteristics. For example, some reports propose that a less restrictive SBP target might be recommended for older patients, especially those with cognitive impairment (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Nevertheless, recent studies suggest that even frail patients benefit from intensive blood pressure control, with frail patients being predominantly those categorized as elderly or very elderly (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Moreover, several studies have provided evidence indicating a reduction in stroke risk among older patients following antihypertensive treatment (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This would involve not only antihypertensive medication but also the implementation of appropriate lifestyle modifications, including physical exercise and smoking cessation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). These measures are of particular significance in the elderly population, as they are more prone to a sedentary lifestyle (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, very elderly patients, received fewer statins compared to other patient subgroups. This is of particular importance, as it has been established that statins offer significant benefits in reducing stroke risk in the elderly population (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Additionally, alternative lipid-lowering treatments have not been shown to confer a comparable reduction in stroke risk as statins, and as such, they are not currently endorsed as first-line therapeutic options (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWith respect to the use of antithrombotic agents in secondary stroke prevention, it is necessary to underline the low prescription rates of antithrombotic drugs, especially in the first months after stroke: only 72% of patients were prescribed with antiplatelet therapy during the first year, with similar rates between age subgroups. In this context, a cohort study from Switzerland, reported that as many as 20% of patients with a recurrent history of ischemic stroke/TIA were not receiving antithrombotic therapy at the time of their recurrence (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Conversely, among patients with atrial fibrillation, anticoagulation rates in our series were higher than those documented in a systematic review of patients with atrial fibrillation and high stroke risk (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). We hypothesize that the widespread use of direct oral anticoagulants (DOACs) may have contributed to the increased rate of anticoagulant therapy over the past decade. However, this increase could also be explained by the fact that our analysis focused on secondary prevention, and the previous reported study included primary and secondary prevention. Nevertheless, even though atrial fibrillation becomes more common with age, we found a trend towards a lower prescription of OAC in the elderly group. These findings are consistent with previous literature (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Nonetheless, as people age, the overall benefit of oral anticoagulation (OAC) grows, as it helps reduce the increasing stroke risk while weighing against the risk of severe bleeding (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Thus, use of OAC in elderly and very elderly should be encouraged.\u003c/p\u003e\u003cp\u003eRegarding the study's design and scope, this study has several advantages, as well as limitations due to to its design.\u003c/p\u003e\u003cp\u003eOn the one hand, PADRIS database includes data from the Catalan public health system, and follow-up from private healthcare providers is not included. However, only 32% of habitants in the region have an additional private insurance, and the percentage decreases to 21% for people aged 65 or older (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Finally, other important variables like compliance with prescribed medical therapy, physical activity, or smoking habits were missing (history of smoking was recorded, but not smoke cessation). Additionally, it is important to emphasize that the relationship between risk factor control and stroke recurrence has not been addressed. Nevertheless, we have already studied this issue in a separate publication (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the other hand, this study has the advantage of providing insight into real-world management of follow-up after an ischemic stroke. Additionally, the large sample size enhances the statistical power and generalizability of the findings to the broader population of stroke survivors. The use of routinely collected data from a comprehensive regional health database allows for an accurate reflection of everyday clinical practice. Furthermore, longitudinal follow-up facilitates the evaluation of treatment patterns and risk factor control over time, while the inclusion of diverse age groups, including elderly and very elderly patients, provides important information on age-related differences in secondary prevention.\u003c/p\u003e\u003cp\u003eIn conclusion, improving the management of vascular risk factors is crucial for effectively reducing the recurrence of stroke and major cardiovascular events among stroke survivors. Nevertheless, this management was found to be suboptimal after hospital discharge. Furthermore, in elderly patients, we observed a noticeable trend towards under-treatment of atrial fibrillation as well as a poor control of certain risk factors such as blood pressure. This highlights a potential gap in the management of stroke prevention within this age subgroup. To address this, several initiatives in our region have been implemented to improve communication between patients and medical professionals as well as among different levels of healthcare providers (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Future studies should determine if an improved communication with primary care providers leads to a more rigorous control in secondary prevention and improved outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrs Ribo and Molina are cofounders and hold stock from Nora. Dr Colangelo is the CTO of NoraHealth. Dr Ribo holds stocks from Anaconda Biomed and reported receiving personal \u0026nbsp;fees \u0026nbsp; from \u0026nbsp;AptaTargets, \u0026nbsp;Cerenovus, \u0026nbsp; Medtronic, \u0026nbsp;Methinks, \u0026nbsp;Philips, and Stryker outside the submitted work. Dr Rubiera reported compensation from Bayer for data and safety monitoring services outside the present work. The other authors report no conflicts\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePRERISK project \u0026nbsp; \u0026nbsp;was \u0026nbsp; supported \u0026nbsp; by \u0026nbsp; \u0026nbsp;Fundación \u0026nbsp; Instituto \u0026nbsp; Carlos \u0026nbsp; \u0026nbsp;III \u0026nbsp; under \u0026nbsp; grant \u0026nbsp; \u0026nbsp;PI20/01768, \u0026nbsp;by \u0026nbsp;Ministerio \u0026nbsp; de \u0026nbsp;Asuntos \u0026nbsp;Económicos \u0026nbsp; y \u0026nbsp;Transformación \u0026nbsp;Digital under \u0026nbsp; grant \u0026nbsp;MIA.2021.M02.0005, \u0026nbsp;and \u0026nbsp; by \u0026nbsp;the \u0026nbsp;European \u0026nbsp; Commission \u0026nbsp;under \u0026nbsp;the Horizon Europe grant 101057263\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuarantor\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors´Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMI, MO and MRu conceived and \u0026nbsp;participated in the design of this study. FR, GC and DD were involved in patient recruitment and data analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from the local ethical committee (PR(AG)107/2020).\u0026nbsp;All participants provided informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this is a registry study the medical ethics committee waived the need for obtaining informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected for this study is available from [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBonita R. 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Available from: https://harmonicsproject.eu.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Secondary prevention, ischemic stroke, vascular risk factor","lastPublishedDoi":"10.21203/rs.3.rs-7973410/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7973410/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe risk of recurrent stroke can be reduced by controlling modifiable risk factors such as hypertension, hypercholesterolemia, and diabetes. In this context, the aim of this study was to assess the level of control of these key factors in a representative cohort of stroke survivors residing in Catalonia, Spain. The analysis was conducted according to the current European Stroke Organisation (ESO) guidelines, with special emphasis on the elderly population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn observational, retrospective, longitudinal study was conducted using data from the population-based database of the Health Quality and Assessment Agency of Catalonia. Patients diagnosed with ischemic stroke or transient ischemic attack (TIA) between 2014 and 2019 were included and followed for one year. Data were collected on blood pressure, cholesterol, and HbA1c levels, as well as on pharmacological treatment, including antithrombotic agents. A comparative analysis was performed across age groups, focusing particularly on elderly (\u0026gt;\u0026thinsp;67 years) and very elderly (\u0026gt;\u0026thinsp;87 years) stroke survivors. In total, 35,918 patients were included in the analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 35918 included patients, 54% were men and the median age was 77 years (IQR 68\u0026ndash;88); 9336 (23%) were older than 87 years. During follow up, blood pressure data were available for 63% of patients. Among them, 49% of individuals aged 18\u0026ndash;67 years and 42% of the very elderly achieved the target of \u0026lt;\u0026thinsp;130 mmHg. LDL-cholesterol levels were available for 5% of patients, with 31% of the younger group and 35% of the very elderly reaching the \u0026lt;\u0026thinsp;70 mg/dL target. Among patients with diabetes, HbA1c was assessed in 84%, and 81% of younger versus 83% of very elderly patients met the \u0026lt;\u0026thinsp;7% target. The prevalence of atrial fibrillation increased significantly with age; however, very elderly patients were less likely to receive oral anticoagulants (63% vs. 72\u0026ndash;73%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eA substantial proportion of stroke survivors did not achieve the targets recommended by the ESO for secondary prevention. In the elderly population, fewer patients reached optimal blood pressure control, and anticoagulant use among those with atrial fibrillation was suboptimal. Efforts to improve risk factor management and adherence to guidelines are needed, with particular attention to older adults.\u003c/p\u003e","manuscriptTitle":"Vascular risk factors after stroke in the elderly: a population-based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:53:02","doi":"10.21203/rs.3.rs-7973410/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"306940744906543917678535906845650380707","date":"2026-05-18T10:09:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T16:35:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137575662786135724208309792441550155167","date":"2025-11-28T15:29:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-28T14:49:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-04T08:47:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-04T01:41:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-04T01:41:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-28T19:29:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ff17e28-824b-4188-88fd-a3cbb1b416c4","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"306940744906543917678535906845650380707","date":"2026-05-18T10:09:58+00:00","index":90,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T14:53:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:53:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7973410","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7973410","identity":"rs-7973410","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}