"Alarming" Lack of Effort to Prevent Second Heart Attack or Stroke Found by UB Researchers

BUFFALO, N.Y. - With mortality looming, people who have survived one heart attack or stroke would do everything possible to avoid a second. Right?

Wrong.

A study conducted by researchers at the University at Buffalo using information from a national population-based database, indicates there is "an alarming magnitude of inadequate secondary prevention in the U.S. population."

Analysis of medical data from individuals who survived a heart attack or stroke showed that:

o More than half of survivors diagnosed with uncontrolled high blood pressure before the attack still had hypertension

o Another 11 percent of survivors were found to have previously undiagosed hypertension

o 46 percent of the survivors with dangerously high cholesterol before the attack still had high cholesterol

Results of the study, conducted by Adnan I. Qureshi, M.D., UB assistant professor of neurosurgery, appear in the July 9 issue of Archives of Internal Medicine. The research was conducted through UB's Toshiba Stroke Research Center and the Department of Neurosurgery in the UB School of Medicine and Biomedical Sciences.

"Persons who have suffered a stroke or heart attack are at very-high risk for subsequent stroke or heart attack," Qureshi said. "The study raises important questions about the adequacy of secondary prevention in a population at very-high risk for subsequent cardiovascular events."

Efforts to address this issue would have to be directed at both doctors and patients, he said.

"First, physicians would have to accelerate their efforts in monitoring and treating cardiovascular risk factors in people who survive initial cardiovascular events. Second, patients must recognize the great risk they face of having another cardiovascular event and accept responsibility for reducing that risk."

The researchers used data from the most recent National Health and Nutrition Examination Survey (NHANES III) in their analysis. NHANES III was conducted between 1988 and 1994 by the Centers for Disease Control to estimate the prevalence of chronic disease in the U.S. population and identify factors that place persons at risk of developing chronic health problems. It involved 40,000 persons 2 months old and older.

Within this population, 1,252 people who had survived a heart attack or stroke became the target for Qureshi's investigation.

Within this group, 738 people reported they had been diagnosed with hypertension, the major risk factor for stroke, before taking part in the NHANES survey. Blood-pressure measurements at the time of the survey showed that 388 of this group, or 53 percent, continued to have dangerously high blood pressure.

The findings were similar for high cholesterol, another major risk factor for heart attack and stroke. Of the 405 survivors who had had high cholesterol readings before the survey, 46 percent continued to have dangerous high-cholesterol levels, according to blood samples taken for NHANES survey.

In addition, blood samples identified 138 persons who had developed hypertension and 160 people who had developed high cholesterol since their initial heart attack or stroke. Moreover, 18 percent of survivors continued to smoke.

"This study lays the basis for developing programs aimed at preventing a second stroke or myocardial infarction in patients at very high risk," Qureshi said. "Such programs could significantly reduce the number of cardiovascular events and prevent a great deal of pain and suffering."

Also participating in the study were M. Fareed K. Suri, M.D.; Lee R. Guterman, M.D., and L. Nelson Hopkins, M.D., all of the UB Department of Neurosurgery and the UB Toshiba Stroke Research Center.