ABSTRACT NUMBER: ESOC2026A2261 OBESITY AND RESIDUAL RISK AFTER CVA IN RURAL ENGLISH PRIMARY CARE: A REAL-WORLD SECONDARY PREVENTION ANALYSIS

Abstract Background and aims Excess body weight is a modifiable risk factor for recurrent events following CVA/TIA. Guidance emphasise weight optimisation as part of comprehensive secondary prevention, yet real-world data from rural primary care are sparse. This review examined residual risk related to body mass index (BMI) in patients with established CVA/TIA managed in rural general practice in England, incorporating healthcare professional (HCP) insights. Methods A retrospective review of anonymised electronic primary care records was conducted in a rural practice in England. Adults with a documented history of CVA/TIA were included. Extracted variables included age, gender, BMI, cardiometabolic comorbidities, blood pressure, lipid levels, and carer status. The review was undertaken as a service evaluation with local ethics approval. BMI categories were assessed against NICE and European Stroke Guidance, with consideration of current National Health Service obesity strategies. Results The cohort comprised 273 patients (mean age 72.8±12.9years; 50.5% male). Mean BMI was 28.0±5.6kg/m2. Overweight and obesity (BMI≥25kg/m2) were present in the majority of patients, with a substantial proportion meeting criteria for obesity. Elevated BMI frequently co-existed with hypertension, diabetes, and chronic kidney disease, compounding secondary prevention risk. HCP insights highlighted limited capacity for structured weight-management interventions in rural settings, particularly among older, multimorbid patients and those with carers. Conclusions In rural primary care, overweight and obesity remain prevalent after CVA/TIA, representing a source of risk despite good control of other factors. Alignment with guidance supports integration of weight-management strategies into secondary prevention, which should be tailored to the rural setting. Conflict of interest VS nil