Annual Trends in Risk Factor Control Status at the Time of Ischemic Stroke in South Korea

Abstract

Background: This study aimed to evaluate secular trends in the control of major risk factors at the time of ischemic stroke to assess the real-world implementation of prevention guidelines and identify areas needing greater clinical attention for improved early stroke outcomes. Methods: We retrospectively analyzed data from a prospective, multicenter, nationwide registry of consecutive patients with acute ischemic stroke between 2011 and 2022. For risk factor controls of interest, hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) were considered. Well-controlled risk factors were defined as follows: "well-controlled hypertension": hypertension with prior antihypertensive medication and systolic blood pressure <140 mm Hg on admission; "well-controlled diabetes": prior antidiabetic medication with glycated hemoglobin <7.0%; "well-controlled dyslipidemia": prior statin therapy with low-density lipoprotein cholesterol <100 mg/dL; and "well-controlled AF": presence of AF with prior oral anticoagulant use. Linear trends in control rates were tested via the Cochran-Armitage and linear contrast tests. Results: Among 76 962 patients (68.8 +/- 13.3 years;men, 59.0%), the adjusted rate of well-controlled hypertension decreased from 35.7% (95% CI, 34.0%-37.5%) in 2011 to 25.5% (95% CI, 24.4%-26.7%) in 2022, whereas well-controlled status improved for diabetes (26.4%-29.4%), dyslipidemia (22.2%-48.6%), and AF (26.0%-55.7%) from 2011 to 2022 (P-trend<0.001). The rates of well-controlled risk factors were relatively higher in patients with a history of stroke than in those with no history of stroke, except for hypertension. The 3-month composite of stroke, myocardial infarction, and all-cause death significantly declined from 10.0% in 2011 to 8.6% in 2022 (P-trend<0.001). Conclusions: Our study confirmed a continuous increase in prestroke risk factor control, including diabetes, dyslipidemia, and AF, but the rate remained suboptimal at stroke onset. These findings may help inform strategies to improve risk factor management by identifying priority areas that warrant targeted intervention in clinical practice and population-level guidelines.