AHA Forum: Secondary Prevention Neglected for Hemorrhagic Stroke Survivors

WASHINGTON, May 10 -- When the stroke is hemorrhagic, secondary prevention measures are significantly less likely to be initiated than when the event is ischemic, researchers said here.

That finding emerged from a three-year study of 188,982 stroke patients treated at 662 hospitals, conducted by members of the American Heart Association's Get With The Guidelines Steering Committee, reported Eric E. Smith, M.D., M.P.H., of Massachusetts General Hospital, and colleagues.

The use of each of four interventions to prevent a recurrence -- lipid-lowering, diabetes control, weight loss, and smoking cessation -- was significantly less in hemorrhagic stroke survivors than after an ischemic stroke or TIA, the investigators reported today at the AHA's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Dr. Smith cautioned, however, that in one case -- use of statin therapy -- the prescribing pattern could reflect a concern about "the known association between low cholesterol levels and an increased risk for intracranial hemorrhage."

In that case, he said, the physician's decision to withhold statin therapy may reflect the clinician's assessment of the patient's risk for a cardiovascular event -- or an ischemic cerebrovascular event -- against the risk of a second brain bleed.

The majority of patients (166,284) suffered ischemic strokes or TIAs, but the study included 17,195 patients who survived intracranial hemorrhage and 5,503 patients who had subarachnoid hemorrhage.

Last week the American Stroke Association and the AHA published guidelines on acute management of intracranial hemorrhage, but Dr. Smith said the results of this study suggest, "guidelines for secondary prevention of cerebrovascular and cardiovascular disease following hemorrhagic stroke may be warranted."

Among the findings:

• On average patients with intracranial hemorrhage were a year younger than ischemic stroke patients (P