J Neurol (2004) 251 : 529–536 DOI 10.1007/s00415-004-0357-8 ORIGINAL COMMUNICATION Marie Girot Dominique Deplanque Florence Pasquier Alain Destée Didier Leys Comparison of secondary vascular prevention in practice after cerebral ischemia and coronary heart disease Introduction In Western countries,vascular diseases in adults,includ- ing stroke and coronary heart diseases (CHD) are the leading causes of death, physical disability and depen- dency [1, 2]. Symptomatic and asymptomatic CHD are associated with stroke [3, 4], even in the absence of arte- rial hypertension or cardiac failure [5]. The risk of stroke increases with the severity of angina pectoris [6]. Besides improving survival and quality of life after the acute event, the objectives of care in patients with CHD or cerebral ischemia are to reduce the risk of a new vas- cular event, in the same or other vascular bed. Guidelines for secondary prevention are regularly published and updated by scientific societies [7, 8]. Lo- JON 1357 ■ Abstract Background Secondary prevention measures in patients with cerebral ischemia or coronary heart disease (CHD) consist of vas- cular risk factors management and Received: 23 July 2003 Received in revised form: 19 November 2003 Accepted: 25 November 2003 M. Girot, MD · D. Deplanque, MD, PhD · F. Pasquier, MD, PhD · A. Destée, MD, PhD · D. Leys, MD, PhD () Dept. of Neurology and Stroke Dept. University of Lille, Roger Salengro Hospital 59037 Lille, France Tel.: +33-320/446813 Fax: +33-320/446028 E-Mail: dleys@chru-lille.fr D. Deplanque, MD, PhD Dept. of Pharmacology University of Lille Lille, France Funding: Research groups on cognitive decline in vascular and degenerative dis- orders and on pharmacology of cell protec- tion in neurovascular and cardiovascular diseases (EA 2691 and EA 1046 from the Ministère de l’Education Nationale, de la Recherche et de la Technologie, MENRT). antithrombotic therapy. The aim of this study was to compare how sec- ondary prevention measures are applied in practice between pa- tients with a history of CHD or cerebral ischemia. Method We com- pared vascular risk factors man- agement and antithrombotic ther- apy between patients with a history of CHD and patients with a history of cerebral ischemia that occurred 2 months to 6 years earlier. Whether patients were properly treated or not was determined by a comparison between their current treatments and European guide- lines for stroke and CHD manage- ment. Results We included 107 con- secutive patients with a history of cerebral ischemia and 85 consecu- tive patients with a history of CHD. We found that: (i) most patients did not receive an appropriate sec- ondary prevention in both groups: 76 of 107 patients with previous cerebral ischemia (71 %) and 73 of 85 patients with CHD (85.9 %); (ii) identification of risk factors, such as hypercholesterolemia, diabetes mellitus and smoking, did not dif- fer between both groups, but arter- ial hypertension was more frequent in CHD patients; (iii) an inappro- priate management of risk factors was more frequent in patients with TIA vs. ischemic stroke, and angina pectoris vs. myocardial infarction; (iv) arterial hypertension and hy- percholesterolemia were the 2 more frequent risk factors that were not properly treated; (v) more than half diabetic patients had hy- perglycemia ≥ 126 mg/dl in both groups; (vi) patients with previous CHD had twice more frequently stopped smoking than those with cerebral ischemia. Conclusion Many patients were not properly treated in both groups, and differ- ences between practice and guide- lines were more frequent in the CHD group, where guidelines are more strict. ■ Key words stroke · myocardial infarction · TIA · angina pectoris · prevention 529-536_Leys_JON_1357 03.05.2004 07:32 Uhr Seite 529