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

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.