{
  "abstract": "Background and purpose\n\nRecurrent ischemic stroke is a sentinel audit point for secondary prevention delivery. We quantified attainment of prevention indicators, sex- and age-related heterogeneity, and projected prevention gains.Methods\n\nWe analyzed 24,183 recurrent ischemic stroke admissions from 81 Korean Stroke Registry hospitals (2018-2023). Annual attainment of antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, glycated hemoglobin (HbA1c) <7.0% in diabetes, non-current smoking, and normal weight (body mass index [BMI] 18.5-24.9 kg/m²) was age-standardized descriptively; temporal trends were assessed with hospital-clustered generalized estimating equation models. Projections combined observed implementation gaps with trial-derived relative risk reductions.Results\n\nAntithrombotic use increased from 74.6% to 79.4% (odds ratio [OR]/year 1.05, 95% confidence interval 1.01-1.09), but plateaued after 2019, leaving 20.6% untreated in 2023. Among 4,441 patients with known atrial fibrillation (AF), oral anticoagulant use rose from 65.3% to 73.3% (OR/year 1.08; P=0.005), and 26.7% remained untreated. LDL-C <70 mg/dL improved from 32.6% to 41.9% (OR/year 1.08; P<0.001), whereas HbA1c, smoking, and weight indicators showed limited overall progress. Heterogeneity emerged: non-current smoking improved in men but not women (already near ceiling, approximately 95%); LDL-C control did not improve in adults aged 19-49 years; and BMI ≥25 kg/m² rose from 36.2% to 56.2% in this age group. Upper-bound projections estimated approximately 183, 126, and 201 potentially preventable recurrent strokes per year within the registry (not national estimates) from antithrombotic non-use, anticoagulant non-use in AF, and LDL-C gaps in large-artery atherosclerosis, respectively.Conclusions\n\nRecurrent-stroke admission revealed persistent, unevenly distributed prevention gaps. Medication reconciliation, AF detection and anticoagulation, lipid intensification, and tailored behavioral pathways should be prioritized.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.",
    "Institute of Public Health and Care, Seoul National University Hospital, Seoul, Korea.",
    "Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.",
    "Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.",
    "Department of Neurology, Seoul Chuk Hospital, Seoul, Korea.",
    "Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea.",
    "Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.",
    "Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.",
    "Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.",
    "Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea.",
    "Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.",
    "Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.",
    "Department of Neurology, Seoul Medical Center, Seoul, Korea.",
    "Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.",
    "Clinical Research Center, Asan Medical Center, Seoul, Korea.",
    "Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.",
    "Department of Neurology, National Medical Center, Seoul, Korea.",
    "Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.",
    "Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. jungkh@gmail.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Eung-Joon Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Matthew Chung"
    },
    {
      "affs": [
        2
      ],
      "name": "Han-Yeong Jeong"
    },
    {
      "affs": [
        3
      ],
      "name": "Jayoun Kim"
    },
    {
      "affs": [
        3
      ],
      "name": "Nan Hee Park"
    },
    {
      "affs": [
        4
      ],
      "name": "Min Kyoung Kang"
    },
    {
      "affs": [
        5
      ],
      "name": "Dongwhane Lee"
    },
    {
      "affs": [
        6
      ],
      "name": "Jinkwon Kim"
    },
    {
      "affs": [
        7
      ],
      "name": "Yo Han Jung"
    },
    {
      "affs": [
        8
      ],
      "name": "Sungwook Yu"
    },
    {
      "affs": [
        9
      ],
      "name": "Wook-Joo Kim"
    },
    {
      "affs": [
        10
      ],
      "name": "Han-Jin Cho"
    },
    {
      "affs": [
        11
      ],
      "name": "Kyungbok Lee"
    },
    {
      "affs": [
        12
      ],
      "name": "Tai Hwan Park"
    },
    {
      "affs": [
        13
      ],
      "name": "Mi Sun Oh"
    },
    {
      "affs": [
        14
      ],
      "name": "Ji Sung Lee"
    },
    {
      "affs": [
        15
      ],
      "name": "Joon-Tae Kim"
    },
    {
      "affs": [
        16
      ],
      "name": "Byung-Woo Yoon"
    },
    {
      "affs": [
        5
      ],
      "name": "Jong-Moo Park"
    },
    {
      "affs": [
        17
      ],
      "name": "Hee-Joon Bae"
    },
    {
      "affs": [
        18
      ],
      "name": "Keun-Hwa Jung"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0x940agbe8p9z.bib",
  "cited_by": 0,
  "doi": "10.5853/jos.2026.02761",
  "fulltext_url": "https://europepmc.org/articles/PMC13678334",
  "id": "0x940agbe8p9z",
  "issns": [
    "2287-6391",
    "2287-6405"
  ],
  "landing_url": "https://europepmc.org/article/MED/42894453",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7220743056",
  "pdf_url": "https://europepmc.org/articles/PMC13678334?pdf=render",
  "pmcid": "PMC13678334",
  "pmid": "42894453",
  "published": "2026-09-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0x940agbe8p9z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "MED:42894453",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42894453"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.",
  "title_text": "Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/0x940agbe8p9z",
  "venue": "Journal of stroke",
  "versions": []
}