Search

Background and purposeAccurate identification of risk factors for stroke is important for public health promotion and disease prevention. HDL cholesterol is a potential risk factor, yet its role in stroke risk is unclear, as is whether HDL cholesterol content or particle number might be a better indicator of stroke risk. Furthermore, the degree to which ethnicity moderates the risk is unknown. As such, the current study examines the associations between incident stroke and both HDL cholesterol concentration and particle number, and assesses the moderating role of race and ethnicity.MethodsThe sample is a racially diverse cohort of US adults between the ages of 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis between 2000 and 2002 and followed until December 2011. The associations among cholesterol content and stroke risk, particle number and stroke risk, and the interaction with race were explored.ResultsThe incidence of stroke was 2.6%. HDL cholesterol concentration (mmol/L) (Hazard Ratio (HR) = .56; 95% Confidence Interval (CI): .312-.988) and number of large HDL particles (μmol/L) (HR = .52, CI: .278-.956) were associated with lower stroke risk. When interactions with race were evaluated, the relationship between both HDL variables and stroke were significant in Blacks, but not other races.ConclusionsHigher HDL cholesterol and a higher concentration of large particles are associated with lower risk of stroke in Blacks. Further research is needed to elucidate the mechanisms by which HDL subfractions may differentially affect stroke outcome in different races/ethnicities.

Many individuals who have had a stroke leave the hospital without postacute care services in place. Despite high risks of complications and readmission, there is no standard in the United States for postacute stroke care after discharge home. We describe the rationale and methods for the development of the COMprehensive Post‐Acute Stroke Services (COMPASS) care model and the structure and quality metrics used for implementation. COMPASS, an innovative, comprehensive extension of the TRAnsition Coaching for Stroke (TRACS) program, is a clinician‐led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home. The effectiveness of the COMPASS model is being assessed in a cluster‐randomized pragmatic trial in 41 sites across North Carolina, with a recruitment goal of 6,000 participants. The COMPASS model is evidence based, person centered, and stakeholder driven. It involves identification and education of eligible individuals in the hospital; telephone follow‐up 2, 30, and 60 days after discharge; and a clinic visit within 14 days conducted by a nurse and advanced practice provider. Patient and caregiver self‐reported assessments of functional and social determinants of health are captured during the clinic visit using a web‐based application. Embedded algorithms immediately construct an individualized care plan. The COMPASS model's pragmatic design and quality metrics may support measurable best practices for postacute stroke care. [ABSTRACT FROM AUTHOR]

Objective: Hypertension (HTN) is a major risk factor for stroke and transient ischemic attack (TIA). After a stroke or TIA, blood pressure control becomes even more essential for secondary prevention of stroke. Prior literature has shown that once-daily dosing of blood pressure (BP) medications improved adherence. We hypothesized that once daily BP medications may also improve BP control at follow up and aimed to determine factors that predict adequate BP control after stroke. Methods: We analyzed blood pressures at discharge and at follow-up in 172 adult stroke and TIA patients admitted to a single tertiary care center. Only those with known HTN at time of discharge and seen in follow-up were included in the analysis. Medication dosing was categorized as once-daily dosing vs. more than once daily dosing. Univariate and multivariate logistic regression analyses (adjusted for sex, age, and race) were performed to compare patients with adequate blood pressure control at follow up to those with poorly controlled blood pressure at follow up. Poor BP control was defined as systolic blood pressure (SBP) greater than 140mmHg. Results: The average age of this cohort was 65 yrs (+/- 14) and 51% (88 of 172) of patients were female. Sixty nine percent (118 of 172) of patients were white, 29% (50 of 172) of patients were black, and the remaining 2% (4 of 172) of patients were of other race-ethnicities. One hundred of the 172 patients (58%) were discharged on once daily blood pressure medications and at follow up, 59% (59 of 100) of them had adequate blood pressure control compared to 78% (54 of 69) of the patients on BP meds dosed more frequently. Once daily blood pressure medication frequency was associated with inadequate blood pressure control at follow up (p=0.0089, OR 3.00 CI 1.34-6.71). Fifty eight percent (50 of 87) of patients who did not receive home health, nursing, or therapy visits had adequate BP control at follow up compared to 76% (59 of 77) of patients who did. Patients with home health nurse or therapy visits were more likely to have adequate BP control at follow up (p=0.0095, OR 0.44; CI 0.21-0.96). Mean discharge SBP of those patients with adequate BP at follow-up was 135mmHg, whereas those with poor control at follow-up had a mean discharge SBP of 145mmHg. Adequate SBP at the time of discharge also predicted adequate blood pressure at follow up (p=0.0006, OR 1.42; CI 1.15-1.77). Conclusions: Contrary to our hypothesis, once daily dosed BP medications did not improve the effectiveness of BP control at follow-up. Elevated SBP at the time of hospital discharge was associated with poor blood pressure control. Those patients receiving outpatient home health and therapy visits after hospital discharge had better blood pressure control. Further studies need to be done to assess medication adherence to determine whether the poor control was related to choice of medication or patient medication-taking behavior. [ABSTRACT FROM AUTHOR]