Key result
Post-stroke secondary prevention remains suboptimal, with only 22% of patients achieving target LDL-C at one year.
Cohort (n=52,400)
Yes
Secondary prevention of stroke with lipid and blood pressure management remains suboptimal in routine clinical practice, highlighting a significant opportunity for quality improvement.
Background and aims To assess the effectiveness of blood pressure (BP) and lipid management in the year following a first diagnosis of stroke. Methods A retrospective observational cohort study using routine electronic health-records of 52,400 incident stroke patients with at least one year follow-up in Wales (2010-23), including 33,080 ischaemic strokes (IS), 4,403 haemorrhagic stroke (HS) and 14,920 unspecified strokes (US) with at least one year follow-up in Wales (2010-23). Results Altogether, 17% of IS patients, 59% of HS and 23% of US were not prescribed any lipid lowering therapy (LLT) in the year post stroke. Only 22% of IS, 9% of HS and 20% of US had a documented LDL-C <1.8mmol/L. In multivariable regression analyses, a history of diabetes and prescription of LLT were independently associated with a greater likelihood of a documented LDL-C level; male sex and LLT were associated with a higher likelihood of documentation of LDL-C <1.8mmol/L. Overall, 84% ,79% and 85% of IS, HS and US patients respectively, had BP documented in their primary care record and 67%, 64% and 67% had a documented BP <140/90mmHg in the year following their stroke. Prescription for antihypertensives and history of diabetes mellitus were independently associated with a greater likelihood of a documented BP in the year following diagnosis in multivariable regression analyses. Conclusions Testing, treatment and control of lipids and blood pressure were suboptimal amongst these very high-risk patients. These data show significant opportunity for improving secondary prevention of stroke in this high risk population. Conflict of interest
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Hewitt et al. (2026) conducted a cohort in Incident stroke (n=52,400). Lipid and blood pressure management was evaluated on Prescription of lipid lowering therapy, documented LDL-C <1.8mmol/L, and documented BP <140/90mmHg. In a cohort of 52,400 incident stroke patients, secondary prevention was suboptimal, with only 22% of ischaemic stroke patients achieving LDL-C <1.8mmol/L and 67% achieving BP <140/90mmHg at 1 year.
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