Pre-morbid Risk Factor Control Differences by Age in Patients Undergoing Thrombectomy for Acute Ischemic Stroke
Objective:
We proposed to estimate the percentage of large vessel strokes that are potentially attributable to unmanaged vascular risk factors and how this may differ by age to improve stroke prevention and patient outcomes.
Background:
Controlling metabolic and behavioral risk factors may avert 75% of the world stroke burden. We anticipate risk factors, and their management may differ depending on age of patient and may offer insight into preventative strategies.
Design/Methods:
A retrospective chart review was conducted on patients undergoing endovascular therapy from 2012-2019 at University of Maryland. Patients were stratified based on age into three groups: <50, 50-70, and >70 years of age. Risk factors prior to admission including hypertension, diabetes, hyperlipidemia, atrial fibrillation, history of vascular disease, and current smoking were recorded. A possibly preventable stroke was defined as having a history of at least one of these risk factors that was not being optimally controlled according to current guidelines. Chi squared tests of proportion were used to evaluate differences between age groups.
Results:
396 patients underwent thrombectomy (50% female, mean age 64.7). The most prominent etiology of stroke across all age groups was cardioembolic. 62% of strokes in patients <50 years of age were preventable as compared to 82% in patients 50-70 years old and 79% in patients older than 70. Smoking was a common risk factor in all age groups. Despite overall lower incidence of diabetes and hyperlipidemia in patients <50 with stroke, a large proportion of these patients presented with poor control of these risk factors (p=0.04 and p=0.01).
Conclusions:
Most patients who underwent thrombectomy had at least one cardiovascular risk factor that was uncontrolled despite age group. This illustrates the importance of cardiovascular risk factor management in primary prevention of stroke, especially control of diabetes and hyperlipidemia in the younger population.