{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:41:47Z","timestamp":1792456907206,"version":"4.5.0"},"reference-count":32,"publisher":"Korean Stroke Society","issue":"3","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["2026-ER1003-00"],"award-info":[{"award-number":["2026-ER1003-00"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["j-stroke.org"],"crossmark-restriction":true},"short-container-title":["J Stroke"],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:p>Background and Purpose Recurrent 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 We analyzed 24,183 recurrent ischemic stroke admissions from 81 Korean Stroke Registry hospitals (2018\u20132023). Annual attainment of antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) &lt;70 mg\/dL, glycated hemoglobin (HbA1c) &lt;7.0% in diabetes, non-current smoking, and normal weight (body mass index [BMI] 18.5\u201324.9 kg\/m\u00b2) 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 Antithrombotic use increased from 74.6% to 79.4% (odds ratio [OR]\/year 1.05, 95% confidence interval 1.01\u20131.09), 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 &lt;70 mg\/dL improved from 32.6% to 41.9% (OR\/year 1.08; P&lt;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\u201349 years; and BMI \u226525 kg\/m\u00b2 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 Recurrent-stroke admission revealed persistent, unevenly distributed prevention gaps. Medication reconciliation, AF detection and anticoagulation, lipid intensification, and tailored behavioral pathways should be prioritized.<\/jats:p>","DOI":"10.5853\/jos.2026.02761","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:49:47Z","timestamp":1791265787000},"page":"437-450","update-policy":"https:\/\/doi.org\/10.5853\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study"],"prefix":"10.5853","volume":"28","author":[{"given":"Eung-Joon","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Institute of Public Health and Care, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Yeong","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayoun","family":"Kim","sequence":"additional","affiliation":[{"name":"Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan Hee","family":"Park","sequence":"additional","affiliation":[{"name":"Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyoung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul Chuk Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwhane","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinkwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yo Han","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungwook","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wook-Joo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Jin","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungbok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai Hwan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Sun","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Asan Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Woo","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Moo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Joon","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1433-8005","authenticated-orcid":true,"given":"Keun-Hwa","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3882","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.122.040073","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.25.2.333","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.110.602615","type":"journal-article"},{"key":"ref4","first-page":"e329","type":"journal-article","volume-title":"Risks of stroke recurrence and mortality after first and recurrent strokes in Denmark: a nationwide registry study","author":"Skajaa","year":"2022"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)30506-2","type":"journal-article"},{"key":"ref6","first-page":"e364","type":"journal-article","volume-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","author":"Kleindorfer","year":"2021"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221100032","type":"journal-article"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.120.028992","type":"journal-article"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2025.40.e74","type":"journal-article"},{"key":"ref10","first-page":"1743","type":"journal-article","volume-title":"Recurrent ischemic strokes: \u201cdiscontinuation of antiplatelet drugs appears to be an important preventable cause\u201d","author":"Mathew","year":"2021"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02384-5","type":"journal-article"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019884517","type":"journal-article"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241253670","type":"journal-article"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12199","type":"journal-article"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2015.08.007","type":"journal-article"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2018.06.009","type":"journal-article"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.7570\/jomes23031","type":"journal-article"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70550","type":"journal-article"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7329.71","type":"journal-article"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007","type":"journal-article"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(13)62343-0","type":"journal-article"},{"key":"ref22","first-page":"9","type":"journal-article","volume-title":"A comparison of two LDL cholesterol targets after ischemic stroke","author":"Amarenco","year":"2020"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2018.312","type":"journal-article"},{"key":"ref24","first-page":"e003661","type":"journal-article","volume-title":"Rising stroke incidence in young adults: more epidemiological evidence, more questions to be answered","author":"B\u00e9jot","year":"2016"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.28513","type":"journal-article"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.9883","type":"journal-article"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000157662.09551.e5","type":"journal-article"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.7314\/apjcp.2013.14.11.6807","type":"journal-article"},{"key":"ref29","first-page":"1160","type":"journal-article","volume-title":"Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization\u2013Lancet Neurology Commission","author":"Feigin","year":"2023"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2021.01571","type":"journal-article"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.01.044","type":"journal-article"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.121.007971","type":"journal-article"}],"container-title":["Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/j-stroke.org\/upload\/pdf\/jos-2026-02761.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/j-stroke.org\/journal\/view.php?doi=10.5853\/jos.2026.02761","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/j-stroke.org\/upload\/pdf\/jos-2026-02761.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:25:56Z","timestamp":1792455956000},"score":1,"resource":{"primary":{"URL":"http:\/\/j-stroke.org\/journal\/view.php?doi=10.5853\/jos.2026.02761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":32,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.5853\/jos.2026.02761","relation":{},"ISSN":["2287-6391","2287-6405"],"issn-type":[{"value":"2287-6391","type":"print"},{"value":"2287-6405","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"2026-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}