Vascular risk factors after stroke in the older people: a population-based study

The risk of recurrent stroke can be reduced by controlling modifiable risk factors such as hypertension, hypercholesterolemia, and diabetes. We aim to assess control of these key factors in a representative cohort of stroke survivors residing in Catalonia, Spain. The analysis was conducted according to the current European Stroke Organisation (ESO) guidelines, with special emphasis on an older population. An observational, retrospective, longitudinal study was conducted using data from the population-based database of the Health Quality and Assessment Agency of Catalonia. Patients diagnosed with ischemic stroke or transient ischemic attack (TIA) between 2014 and 2019 were included. Follow-up data comprised all measurements recorded during the first year after the index event. Data were collected on blood pressure, cholesterol, and HbA1c levels, as well as on pharmacological treatment, including antithrombotic agents. A comparative analysis was performed across age groups, focusing particularly on older people (> 67 years) and very older people (> 87 years) stroke survivors. In total, 35,918 patients were included in the analysis. Of 35,918 included patients, 54% were men and the median age was 77 years (IQR 68–88); 9336 (23%) were older than 87 years. During the first year after stroke, blood pressure data were available for 63% of patients. Among them, 49% of individuals aged 18–67 years and 42% of the very older people achieved the target of < 130 mmHg. Despite blood tests with total cholesterol were available for 59%, LDL-cholesterol was specifically assessed only in 5% of patients, with 31% of the younger group and 35% of the very older people reaching the < 70 mg/dL target. Among patients with diabetes, HbA1c was assessed in 84%, and 81% of younger versus 83% of older people met the < 7% target. The prevalence of atrial fibrillation increased significantly with age; however, older people were less likely to receive oral anticoagulants (63% vs. 72–73%). A substantial proportion of stroke survivors did not achieve the targets recommended by the ESO for secondary prevention. In the older people population, fewer patients reached optimal blood pressure control, and anticoagulant use among those with atrial fibrillation was suboptimal. Our findings highlight the need for structured post-stroke follow-up pathways, improved communication between stroke specialists and primary care physicians, and targeted interventions to optimize cardiovascular risk factor management in older people.