RISK FACTORS FOR CEREBRAL STROKE BASED ON THE STUDY OF PERSONIFICATION AND COMPLIANCE TO THERAPY
Relevance. Stroke is a state medical and social problem, therefore, effective measures aimed at preventing stroke are extremely important. Cerebral stroke is a polyetiological and heterogeneous pathological process that requires an individual approach to stroke prevention. Objective. To assess the possibility of using phenotyping of acute cerebrovascular accident (ACVA) according to the ASCOD gradation with an assessment of treatment compliance to identify the most significant risk factors and develop effective individual primary and secondary prevention of cerebral stroke in certain groups of patients. Methods. The object of the study was 48 patients of working age with acute cerebrovascular accidents who were hospitalized in the department for patients with cerebrovascular accidents at the State Healthcare Institution VOKB No. 1 in Voronezh from 1.10.2019 to 20.04.2020. In retrospective analysis, a list of criteria for stroke risk factors was used. For patients with stroke, special phenotyping was used. The ASCOD system includes: A - atherosclerosis; S - disease of small vessels; C - heart disease; O - other reasons: D - dissection of arteries and allows assessing the contribution of various etiological factors and pathogenetic mechanisms to the onset and development of stroke. Compliance was assessed using the MMAS-8 scale (Morisky-Green). Results. The study involved 48 patients, 76% of them were men, 23% were women. The average age of the patients included in the study was 45-46 years. Among the examined patients, 10 were on treatment with a diagnosis of hemorrhagic stroke (HI), 38 - with a diagnosis of ischemic stroke (IS). Among patients with IS, the atherothrombotic subtype was identified in 20 patients (54%); cardioembolic subtype - in 4 patients (12%); lacunar subtype - in 14 patients (34%). With the help of clinical examination and ASCOD, the subtypes of IS were verified in the following ratio: atherothrombotic - 10 patients; cardioembolic - 4 patients; lacunar - 10 patients, other etiology elucidated - 2 patients, unexplained etiology - 12 patients. When phenotyping - 28 out of 38 patients with ACVA had at least one main identified factor in the development of an ischemic event. Using ASCOD and clinical examination, basic risk factors were identified : in 14 patients (39%) - two or more risk factors, in 40 (83%) - 4 or more risk factors out of 11 indicators of the generally accepted list. Of the frequently detected factors, it was possible to note the lack of blood pressure control - 40 patients (83%) and dyslipidemia with stenosis of the brachiocephalic arteries (BCA) - 24 patients (50%). According to the Moriska scale, 2 patients (4%) had high adherence to treatment, average - 6 patients (12.5%), low -24 patients (50%). A number of patients failed to assess adherence, because these patients were not examined for a long time (except for preventive examinations) and did not receive appointments. Discussion. Taking into account the results of the study, it is possible to offer personal prevention of stroke in cases of insufficient blood pressure control and dyslipidemia with BCA stenoses, the basis of which will be correct antihypertensive therapy and adherence to it, as well as the identification of the severity of BCA dyslipidemia and stenosis with the appointment of adequate lipid-lowering therapy and possible surgical treatment. Conclusion. An individual strategy for the prevention of stroke should include the timely identification of risk factors for stroke, correction of modifiable risk factors, dynamic monitoring of patients with a burdened hereditary history and / or those who have had cerebral stroke with the appointment of correct therapy and compliance to it. In order to identify the most significant risk factors and develop effective individual primary and secondary prevention of cerebral stroke during outpatient and inpatient treatment of patients with cerebrovascular diseases, it is advisable to use ACVA phenotyping according to ASCOD gradation with an assessment of treatment compliance.