Optimal combination treatment and vascular outcomes in recent ischemic stroke patients by premorbid risk level

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:355

Article

Park, Jong-Ho^1,2  Ovbiagele, Bruce² 

[1] Seonam Univ, Myongji Hosp, Dept Neurol, Goyang, South Korea

[2] Med Univ S Carolina, Dept Neurol, Charleston, SC 29425 USA

关键词: High-risk;    Secondary prevention;    Drug;    Stroke;    Vascular events;    Death;   

DOI  :  10.1016/j.jns.2015.05.028

来源: Elsevier

【 摘 要 】

Background: Optimal combination of secondary stroke prevention treatment including antihypertensives, antithrombotic agents, and lipid modifiers is associated with reduced recurrent vascular risk including stroke. It is unclear whether optimal combination treatment has a differential impact on stroke patients based on level of vascular risk. Methods: We analyzed a clinical trial dataset comprising 3680 recent non-cardioembolic stroke patients aged 35 years and followed for 2 years. Patients were categorized by appropriateness levels 0 to III depending on the number of the drugs prescribed divided by the number of drugs potentially indicated for each patient (0 = none of the indicated medications prescribed and III = all indicated medications prescribed [optimal combination treatment]). High-risk was defined as having a history of stroke or coronary heart disease (CHD) prior to the index stroke event. Independent associations of medication appropriateness level with a major vascular event (stroke, CHD, or vascular death), ischemic stroke, and all-cause death were analyzed. Results: Compared with level 0, for major vascular events, the HR of level III in the low-risk group was 0.51 (95% CI: 020-128) and 032 (0.14-0.70) in the high-risk group; for stroke, the HR of level III in the low-risk group was 0.54 (0.16-1.77) and 025 (0.08-0.85) in the high-risk group; and for all-cause death, the HR of level III in the low-risk group was 0.66 (0.09-5.00) and 022 (0.06-0.78) in the high-risk group. Conclusion: Optimal combination treatment is related to a significantly lower risk of future vascular events and death among high-risk patients after a recent non-cardioembolic stroke. (C) 2015 Elsevier B.V. All rights reserved.

【 授权许可】

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