Özet:

Objectives: Cerebrovascular disease is a common health problem. Serebrovascular disease is the second common cause of mortality among persons sixty years and older worldwide1. İt is the leading cause of functional impairment and labor loss1. Determining the etiology of stroke is important in management of risk factors. This study aims at determination of the frequency of known risk factors for stroke and whether these factors are adequetely controlled or not in a population of patients hospitalized for stroke. Materials and Methods: A total of 657 patients hospitalized and treated for the diagnosis of stroke in Ankara Atatürk Education and Research Hospital are included in the study. Medical records of the patients are retrospectively reviewed for the risk factors defined in the results of the study by the World Health Organisation working group  and primary prevention guidelines published by American Heart Association/American Stroke Association 2,3. Results: Ischemic stroke was present in 74.8% (n=491) of the included patients, whereas intracerebral bleeding was present in 16.7% (n=110) and subarachnoid bleeding in 8.5% (n=56). The incidence of stroke under the age of 45 was 6.1%. Of the patients under the age of forty five 47.5% had ischemic stroke and 52.5% hemorrhagic stroke. The diagnosis of hypertension was present in 450 (68.5%) patients, 28 (4.3%) of whom were diagnosed with hypertension after the hospital admission. Among patients with the diagnosis of hypertension, medication compliance was full in 71.3% (n=321), poor in 19.3% (n=87), while 9.3% (n=42) were non-compliant. The diagnosis of diabetes mellitus (DM) was present in 147 (22.4%) patients, 54 (8.2%) of whom were diagnosed with DM after the hospital admission. Ischemic stroke was present in 82.6% of the diabetic patients, compared with 71.3% of non-diabetics. Among diabetic patients 5.4% (n=8) had a poor medication compliance, while 16.3% (n=24) were non-compliant. Median HbA1c level was 7.5 g/dL (IQR: 2.40). Ischemic stroke was present in 86.8% of patients having a serum HDL level below 45 mg/dL, whereas 68.2% of patients having a serum HDL level of 65 mg/dL and above had ischemic stroke. There was a negative association between serum HDL levels and ischemic stroke (Z=2.889; p=0.004). When the patients were grouped as having a serum LDL ≥ 140 mg/dL and < 80 mg/dL, a statistically significant difference was not present between these groups in view of the type of stroke ( c2=0.314; p=0.575). Elektrocardiographic findings on hospital admission showed sinus rhytm in 88.3%, atrial fibrillation (AF) in 11.6% and pacemaker rhytm in 1.0% of the patients. Among patients having AF rhytm 57.1% were not on any anti-coagulant an/or anti-aggregant therapy, 23.4% were on acetylsalycilic acid (ASA), 9.1% on warfarin, 2.6% on clopidogrel, 5.2% on ASA + warfarin, 2.6% on ASA + clopidogrel. Mortality after hemorrhagic stroke was 34.1%, whereas 13.3% after ischemic stroke. Conclusion: Occurrence of stroke and disability ratio due to stroke can be reduced by minimizing the risk factors of stroke .  The frequency of other risk factors, such as diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, sedentary lifestyle are increasing by age and the damage of vascular structure and atherosclerotic changes play an important role in the formation of stroke. Stroke development can minimized by appropriate follow-up and treatment. On behalf of protective medicine, family physicians have an important role in the prevention of stroke.

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