Abstract HUP12: Temporal trends in stroke risk factors among patients with acute ischemic stroke and stroke-free individuals in South Texas: 2011–2023

Background: Recent evidence suggests that the decline in stroke incidence has plateaued in the US, underscoring the need to reassess the burden of stroke risk factors. We examined overall and group-specific trends in the prevalence of key stroke risk factors among patients with incident acute ischemic stroke (AIS) and stroke-free individuals to contextualize the results. Methods: We identified AIS cases from the Brain Attack Surveillance in Corpus Christi Project, Nueces County, TX (2011-2023). We used the Behavioral Risk Factor Surveillance System (2011-2023) to estimate risk factor trends in the stroke-free population in Texas Public Health Region 11. Key risk factors include ever smoking, coronary artery disease (CAD), diabetes, hypertension, and hypercholesterolemia. We used generalized additive models to assess trends and percent change in the predicted prevalence among AIS patients, and survey-weighted logistic regression models for stroke-free individuals. All models were adjusted for age, sex, and ethnicity. Interaction terms were tested to assess effect modification by sex and ethnicity groups. Results: A total of 3764 AIS patients and 9048 stroke-free individuals were included in the analysis. Between 2011-2023, an increasing trend in the prevalence of smoking (20%; 95% CI: 9%, 33%), hypertension (12%, 95% CI: 4%, 21%), and hypercholesterolemia (13%, 95% CI: -1%, 28%), and a significant decline in CAD (-27%; 95% CI: -43%, -13%) was observed in AIS patients, with a stable trend for diabetes (Figure 1). Stroke-free individuals experienced significant declines in smoking (-16%, 95% CI: -23%, -10%), hypertension (-9%, 95% CI: -12%, -5%), and hypercholesterolemia (-29%, 95% CI: -31%, -27%), a 22% (95% CI: 17%, 26%) increase in diabetes prevalence, and stable trends for CAD. Smoking prevalence significantly increased among Mexican American (MA) (54%; 95% CI: 54%, 101%) and remained stable in non-Hispanic White (NHW) AIS patients. In the stroke-free group, smoking declined in MA (19%, 95% CI: 3%, 39%) and increased in NHW respondents (-19%, 95% CI: -35%, -2%) (Figure 2). CAD trends in AIS patients also differed by sex, with a 41% (95% CI: -63%, -21%) decline among males, while remaining stable in females (Figure 3). Conclusion: The prevalence of key risk factors has declined in stroke-free individuals, while increasing among incident AIS patients, indicating an urgent need for tailored prevention strategies to reverse the plateauing trend in stroke incidence.