Challenges in secondary stroke prevention: prevalence of multiple metabolic risk factors, including abnormal glycaemia, in ischaemic stroke and transient ischaemic attack

Background: Secondary prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA) mandates identification and treatment of multiple metabolic risk factors. The aim was to determine the prevalence of abnormal glycaemia, hypertension and dyslipidaemia in patients presenting to an Acute Stroke Unit of a tertiary referral teaching hospital with IS or TIA. Methods: We reviewed the clinical characteristics of consecutive patients presenting with symptoms of acute stroke or TIA between 1 February 2006 and 30 June 2007 to determine the prevalence of diabetes, impaired fasting glucose (IFG), post-stroke dysglycaemia (PSD), hypertension and dyslipidaemia. Results: Mean age +/- SD of the 224 patients (84 female) was 71 +/- 15 years. Seventy per cent (n = 157) of patients presented with IS and 30% (n = 67) with TIA. Of the cohort, 15% (n = 33) had previously diagnosed diabetes, 10% (n = 22) were diagnosed with diabetes during admission and 19% (n = 42) had IFG diagnosed during admission. A further 4% (n = 9) were classified as having PSD. Sixty-two per cent (n = 139) of patients had previously diagnosed hypertension; another 7% (n = 15) were diagnosed during admission. Eighty-eight per cent (n = 197) of patients had dyslipidaemia. Thirty per cent had all three risk factors concurrently. Conclusion: Abnormal glycaemia was present in almost half the patients presenting with IS/TIA, with the majority of cases undiagnosed. One-third of patients had abnormal glycaemia, hypertension and dyslipidaemia concurrently. Patients presenting with stroke should be routinely screened for abnormal glycaemia in concert with other vascular risk factors.