Background and Aims: Stroke is the leading cause of adult disability in North America. Despite the cardiovascular etiology of stroke and its similarities in risk factors to ischemic heart disease, the risk factor profiles of these individuals are not well established. The objective of this study was to characterize the profiles of cardiovascular risk factors among individuals with stroke.
Methods: This study was part of a larger trial investigating the effects of a cardiac rehabilitation program with community dwelling stroke survivors with mild to moderate neurological impairment. A cross-sectional descriptive analysis of established cardiovascular risk factors was conducted for 34 participants prior to commencing the cardiac rehabilitation program (23 men, mean +/- SD age 64 +/- 13 years, time post-stroke 28 +/- 24 months). Risk factors included presence of high blood pressure or diabetes, current smoking, sub-optimal lipid profiles or body composition and history of cardiac disease or previous stroke and/or transient ischemic attack.
Results: Of the 7 (21%) participants who presented with resting blood pressure greater than 140/90 mmHg, 4 (12%) were on anti-hypertensive medications suggesting that therapy was not optimally managed in these individuals. Of greater clinical importance, however, were the remaining 3 (9%) participants were currently untreated for hypertension. Eleven (32%) individuals were diagnosed with type II diabetes, yet fasting glucose levels revealed hyperglycemia in 5 (15%) of these participants, and also in another 3 (9%) individuals without previously identified diabetes. Nine (26%) met the National Cholesterol Education Program-III criteria for metabolic syndrome. Nineteen (56%) participants exceeded recommended targets for waist circumference and 4 (12%) participants were currently smoking. Fasting lipid profiles revealed that 5 (15%) participants had low levels of HDL. Similarly, 5 (15%) individuals also demonstrated high levels of LDL and triglycerides, of which 3 (9%) were on cholesterol-lowering medications while 2 (6%) were not. There were 12 (35%) participants with prior history of cardiovascular disease: stroke (n = 4, 12%), transient ischemic attack (n = 2, 6%), left ventricular hypertrophy (n = 2, 6%), myocardial infarction (n = 2, 6%), coronary artery disease without surgical intervention (n = 1, 3%) and/or coronary artery bypass graft (n = 1, 3%).
Conclusions: Individuals post-stroke present with cardiovascular and stroke risk factor profiles that are outside the recommended targets to reduce the risk of future events, particularly with respect to presence of high blood pressure and diabetes. Of note, a sub-group of participants identified in this cohort appeared to be on sub-optimally managed therapies for hypertension and hyperglycemia; and others were previously unrecognized for these risk factors. Further, one third of the sample also presented with prior history of cardiovascular disease. Given the significant functional limitations that result from stroke and burden on the health care system, targeted risk factor modification programs should be routinely included in the standard model of care for individuals post-stroke for secondary prevention.