TY  - JOUR
A1  - Leistner, Stefanie
A1  - Benik, Steffen
A1  - Laumeier, Inga
A1  - Ziegler, Annerose
A1  - Nieweler, Gabriele
A1  - Nolte, Christian H.
A1  - Heuschmann, Peter U.
A1  - Audebert, Heinrich J.
T1  - Secondary Prevention after Minor Stroke and TIA - Usual Care and Development of a Support Program
JF  - PLoS One
N2  - Background: Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program. 
Methods: Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU). Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed. 
Results: 168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP): 155/84 mmHg) and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg) were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01). LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12). Proportions of patients who stopped smoking were 50 versus 79% (p<0.01). 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09).
Conclusions: Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-)vascular recurrence rates are going to be assessed in a multicenter randomized trial.
KW  - atherothrombosis
KW  - multifactorial
KW  - clinical trial
KW  - hypertension
KW  - disease
KW  - transient ischemic attack
KW  - randomized controlled trial
KW  - cardiovascular risk factors
KW  - blood pressure
KW  - event rates
Y1  - 2012
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135247
VL  - 7
IS  - 12
ER  - 
TY  - JOUR
A1  - Sahiti, Floran
A1  - Morbach, Caroline
A1  - Cejka, Vladimir
A1  - Tiffe, Theresa
A1  - Wagner, Martin
A1  - Eichner, Felizitas A.
A1  - Gelbrich, Götz
A1  - Heuschmann, Peter U.
A1  - Störk, Stefan
T1  - Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study
JF  - Journal of Human Hypertension
N2  - Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops, and has been validated against invasively derived pressure-volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of Würzburg, Germany, aged 30-79 years. Indices of myocardial work were determined in 1929 individuals (49.3% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease.
KW  - myocardial work
KW  - left ventricular performance
KW  - cardiovascular risk factors
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-271770
SN  - 1476-5527
VL  - 36
IS  - 3
ER  -