Abstract DP008: Trends in Vascular Risk Factor Control Among U.S. Adults with Prior Stroke: 1999-2018

Background: Management of modifiable risk factors is the mainstay for the prevention of recurrent stroke. Our objective was to investigate trends in vascular risk factor (hyperglycemia, hyperlipidemia, hypertension, and smoking) control among community-dwelling U.S. adults with prior stroke. Methods: We performed analyses of 1999-2018 National Health and Nutrition Examination Surveys (NHANES) participants with self-reported history of stroke. Meeting guideline-recommended targets for post-stroke risk factor control was defined as follows: hemoglobin A1c (HbA1c) <6.5% for individuals without history of diabetes or HbA1c <7.0% for individuals with a history of diabetes, low-density lipoprotein (LDL) cholesterol <70mg/dL, blood pressure <130/80mmHg, and non-smoking. Age-standardized mean HbA1c, LDL, and blood pressure and prevalence of meeting each guideline target individually and cumulatively were calculated for each four-year epoch. Results: Age-standardized mean HbA1c and blood pressure were stable over time, while mean LDL decreased from 125.5mg/dL (95%CI=117.9-133.0) in 1999-2002 to 110.7mg/dL (95%CI=104.4-117.0) in 2015-2018. From 1999 through 2018, the age-standardized prevalence of individuals meeting guideline recommendations for glycemic control remained stable above 85% and for blood pressure control and smoking remained stable between 50% and 75%. The age-standardized prevalence of individuals meeting guideline recommendations for lipid control increased from 5.1% (95%CI=0-12.3) in 1999-2002 to 23.4% (95%CI=19.9-27.0) in 2002-2006 and subsequently decreased in 2015-2018 (8.8%, 95%CI=4.3-13.3). Fewer than 5% of individuals met guidelines for all four stroke risk factors over this time period, while the proportion meeting two guidelines increased from 46.7% (95%CI=23.8-69.5) to 62.4% (95%CI=51.7-73.1). Discussion: In this nationally representative sample of U.S. adults with stroke, few stroke survivors met guideline recommendations for all risk factors from 1999 through 2018, with an overall stable trend. Despite a significant decrease in the mean measured LDL during the study period, guideline adherence for lipid control was the lowest among the four risk factors evaluated, while adherence to glycemic guidelines was consistently the highest. Our results suggest that current secondary stroke prevention efforts aimed at targeting improved blood pressure, lipid control, and smoking cessation could be improved to reduce the burden of recurrent stroke.