Background and Purpose- Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods- We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results- The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions- A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00861081.

中文翻译：

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一种工具的推导和应用，该工具可估计可降低中风复发风险的多种疗法的收益。

背景与目的-降低血压和胆固醇，使用抗血小板/抗血栓药物和戒烟可以减少中风复发的风险。然而，卒中幸存者之间危险因素控制的差距值得发展和评估旨在同时改善多种危险因素的替代性护理提供模式。护理提供模型的随机试验很少有足够的持续时间或规模来支持低频结果，例如观察到的复发性中风。这就需要一种工具来估计多个卒中危险因素之间的变化如何降低复发性卒中的风险。方法-我们回顾了有关降低血压，降低胆固醇，抗血小板/抗血栓形成，戒烟，并为每种干预措施提取相对风险。据此，我们开发了一种使用自举和模拟方法来估计复发性中风风险降低的工具。我们还计算了修改后的全球成果得分，该得分代表了如果所有4种个体风险因素均得到最佳控制的潜在收益（相对风险降低）的比例。我们使用该工具估算了275名参与者的卒中风险降低，并从一项针对多个卒中危险因素的医疗保健模型的最新发表的随机试验中，获得了12个月的完整随访数据。结果-复发性卒中风险工具是可行的，在实验和常规护理试验组中，缺血性卒中的相对风险估计降低了0.36。全球结果评分结果表明，平均而言，双方的参与者都避免了45％的复发性中风事件，而这可能是通过对所有4种单独的危险因素进行最大程度的干预来预防的。结论-降低中风风险的工具有助于评估多种中风风险因素改善对血管风险的综合影响，并为测试替代治疗模式以预防中风复发的研究提供总结。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT00861081。结论-降低中风风险的工具有助于评估多种中风风险因素改善对血管风险的综合影响，并为测试替代治疗模式以预防中风复发的研究提供总结。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT00861081。结论-降低中风风险的工具有助于评估多种中风风险因素改善对血管风险的综合影响，并为测试替代治疗模式以预防中风复发的研究提供总结。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT00861081。