Modest improvement in risk factor control after admission for a stroke or transient ischemic attack.

BACKGROUND: Although guidelines recommend control of risk factors for secondary stroke prevention, few studies examine the level of risk factor control achieved in a poststroke population. METHODS: We examined medical records of 99 consecutive patients admitted for ischemic stroke or transient ischemic attack to the Department of Veterans Affairs (VA) West Los Angeles Healthcare Center who were still alive 1 year later. Values for blood pressure, low-density lipoprotein, hemoglobin A1c, and body mass index were collected from a time period of up to 6 months before admission and compared with a time period 6 to 13 months after admission. RESULTS: For the entire sample, improvements in risk factor control were detected only in diastolic blood pressure (5 mm Hg) and hemoglobin A1c (0.9%) (P < .05). When analyzing just the subset of patients with suboptimal control before hospitalization, improvements were detected for systolic blood pressure (12 mm Hg), diastolic blood pressure (12 mm Hg), low-density lipoprotein (29 mg/dL), and hemoglobin A1c (1.4%) (all P < .01). However, a majority of patients with suboptimal control of systolic blood pressure, low-density lipoprotein, and body mass index before admission failed to achieve optimal control of that risk factor in the year after admission. Only 23 patients had all relevant risk factors measured in the VA system during the period after admission and had the final measurements of those risk factors in the optimal range. CONCLUSIONS: Although modest improvements were detected, there remains room for improvement in optimizing control of risk factors after a stroke.

Carotid calcification on panoramic radiographs: an important marker for vascular risk.

OBJECTIVE: The objective of this study was to determine whether carotid calcifications are harbingers of future vascular events. STUDY DESIGN: Between 1986 and 2000, 71 patients were found to have carotid artery calcifications on routine panoramic films. Medical records were reviewed for vascular risk factors existing before and vascular end points subsequent to the radiographs. RESULTS: The mean age of our patients was 68 years. Sixty-one (86%) had preexisting vascular risk factors, 73% with multiple risk factors. Forty-one end points occurred in 29 patients. The average time to an end point was 2.7 years. The end points included myocardial infarction (8, 11%), stroke (5, 7%), death (11, 15%), revascularization procedures (8, 11%), transient ischemic attack (2, 3%), and angina (7, 10%). Twenty-three patients (34%) had major end points of myocardial infarction, stroke, or death. CONCLUSIONS: Carotid calcifications identified on panoramic radiographs are powerful markers for subsequent vascular events. Patients found to have carotid calcification on panoramic radiographs should be referred for cerebrovascular and cardiovascular evaluation and aggressive management of vascular risk factors.