ABSTRACT NUMBER: ESOC2026A1447 VASCULAR RISK FACTOR CONTROL AT RECURRENT ISCHEMIC STROKE ADMISSION: TEMPORAL TRENDS AND OUTCOME ASSOCIATIONS FROM A NATIONWIDE REGISTRY

Abstract Background and aims Recurrent ischemic stroke is associated with substantial disability and mortality, but attainment of key secondary-prevention risk-factor targets at recurrent-stroke admission is not well defined. Methods We analyzed adult acute stroke admissions recorded in the Korean Stroke Registry from 2018 to 2023, including 24,183 recurrent ischemic events. Risk-factor benchmarks were hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL, noncurrent smoking, and normal weight (body mass index 18.5–24.9 kg/m2). Temporal trends and effect modification by sex and age group were assessed using hospital-clustered generalized estimating equation logistic models. Associations between the number of controlled risk factors and discharge functional independence, as well as in-hospital mortality, were evaluated with multivariable adjustment. Results The mean age was 72.6 ± 12.3 years, and 39.6% were women. LDL-C control improved over time, with greater annual gains in women than men (odds ratio per year 1.12 vs 1.05; P for interaction<0.001) and improvement confined to patients aged ≥50 years (P for interaction<0.001). Hemoglobin A1c < 7.0% was stable overall, with a borderline decline among patients aged 19–49 years (odds ratio per year 0.90). Noncurrent smoking increased in men but decreased in women (P for interaction<0.001). Normal weight declined in women (P for interaction = 0.010) and younger adults (P for interaction<0.001). Discharge functional independence increased, and in-hospital mortality decreased stepwise with a greater number of controlled risk factors. Conclusions Low-density lipoprotein cholesterol control improved, whereas gaps in glycemic status, smoking, and weight persisted, particularly among younger adults and women. Greater bundled risk-factor control was associated with better outcomes. Conflict of interest Eung-Joon Lee: Nothing to disclose. Figure 1 - belongs to Conclusions