Author response: The dimension of preventable stroke in a large representative patient cohort

We thank Dr. Goldstein for the valuable comment on our article.1 Diabetes is a major risk factor for ischemic stroke and every fifth patient with diabetes dies of stroke.2 Guidelines recommend target control for hypertension and use of statins, whereas the benefit of prophylactic antiplatelet therapy remains controversial.3,4 In our cohort of ischemic stroke and TIA patients, 321 (18.6%) had diabetes and 60 of them were newly diagnosed (3.5% of all stroke/TIA patients). Among diabetic patients, 47.6% had undertreated hypertension, which is similar to the situation in patients without diabetes (45.3%). However, the proportion of patients not receiving adequate antithrombotic therapy—based on previous cardiovascular disease or carotid stenosis—was higher among diabetics (34.6% vs 7.3%, p < 0.001) as was the proportion of inadequately treated hypercholesterolemia (63.6% vs 51.1%, p = 0.002). Overall, risk factor control in diabetic patients was even worse than in non-diabetic patients—the proportions of patients with at least one untreated or inadequately treated risk condition at the time of the index event: 93.8% vs 76.2%, p < 0.001. Substantial improvement in primary prevention is one of the over-arching goals in the Action Plan for Stroke in Europe 2018–2030,5 and concerted actions are required to reduce the worrisome proportion of preventable strokes.

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