Most acute stroke patients have undiagnosed risk factors

In a large, single-centre cohort study, two-thirds of patients with acute ischemic stroke had one or more undiagnosed major vascular risk factors, most notably dyslipidemia, hypertension, and atrial fibrillation (AF). Patients with undiagnosed risk factors were relatively young, were more often women, and had more often a patent foramen ovale (PFO).

A retrospective analysis, performed by Dr André Rêgo (Lausanne University Hospital and University of Lausanne, Switzerland), included 4,354 patients from the ASTRAL registry from 2003–2018, who had been admitted within 24 hours after a stroke [1]. Their median age was 70 years (IQR 15.2) and 44.7% were women.

1,125 patients (25.8%) were unaware of having any major risk factor; mean age in this subgroup was 59 years, as opposed to 74 years in the group with diagnosed risk factors. Within this group, 341 (30.3%) indeed had no undiagnosed major risk factor(s), but 784 (67.7%) did have at least one. Of these, 61.4% had newly detected dyslipidemia, 23.7% had hypertension, 10.2% had AF, 5.2% had diabetes, 2.0% had ejection fraction <35%, and 1.0% had coronary disease. “The results, however, may not be generalisable to other countries, since Switzerland is known for its high-quality healthcare system, high general level of education, and relatively healthy population. If we did this study in another context, we probably would see even more undiagnosed risk factors,” said Dr Rêgo.

Having a major stroke risk factor without being aware of it was associated with lower age, non-Caucasian ethnicity, PFO, contraceptive use, and smoking (in patients ≥55 years old). Also found were negative associations with antiplatelet use before event and a higher BMI. In this group, there was a higher frequency of PFO-related strokes and a lower frequency for large vessel, lacunar, cardiac, or multiple coexisting causes.

Improving the detection of undiagnosed risk factors would require a shift in healthcare focus, according to Dr Rêgo. “We still have a healthcare system excessively directed toward acute disease and less to chronic diseases and preventive medicine.”

1. Rêgo A, et al. Undiagnosed major risk factors in patients with acute ischaemic stroke: clinical profile, stroke mechanisms and outcome. EAN 2022, EOP-261, EAN 2022, 25–28 April, Vienna, Austria.

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Posted on 22 August, 2022