Prescribing all indicated secondary prevention medications after noncardioembolic stroke reduced the risk of recurrent stroke compared to prescribing none (HR 0.39; 95% CI 0.18-0.84).
Cohort (n=3,680)
Yes
Does the optimal combination of secondary prevention medication classes reduce recurrent stroke and major vascular events in patients with recent noncardioembolic stroke?
Optimal combination of evidence-based secondary prevention medications significantly reduces the risk of recurrent stroke, major vascular events, and death in patients with recent noncardioembolic stroke.
Effect estimate: HR 0.39 (95% CI 0.18-0.84)
Absolute Event Rate: 7.3% vs 15.9%
OBJECTIVE: To investigate the effect of optimal combination of evidence-based drug therapies including antihypertensive agents, lipid modifiers, and antithrombotic agents on risk of recurrent vascular events after stroke. METHODS: We analyzed the database of a multicenter trial involving 3,680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Patients were categorized by appropriateness level 0 to III depending on the number of 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). Independent associations of medication appropriateness level with recurrent stroke (primary outcome), stroke/coronary heart disease/vascular death as major vascular events (secondary outcome), and death (tertiary outcome) were assessed. RESULTS: The unadjusted rate of stroke declined with increasing medication appropriateness level (15.9% for level 0, 10.3% for level I, 8.6% for level II, and 7.3% for level III). Compared with level 0: the adjusted hazard ratio of stroke for level I was 0.51 (95% confidence interval, 0.21-1.25), level II 0.50 (0.23-1.09), and level III 0.39 (0.18-0.84); of stroke/coronary heart disease/vascular death for level I 0.60 (0.32-1.14), level II 0.45 (0.25-0.80), and level III 0.39 (0.22-0.69); and of death for level I 0.89 (0.30-2.64), level II 0.71 (0.26-1.93), and level III 0.35 (0.13-0.96). CONCLUSIONS: Optimal combination of secondary prevention medication classes after a recent noncardioembolic stroke is associated with a significantly lower risk of stroke, major vascular events, and death.
Park et al. (Thu,) conducted a cohort in recent noncardioembolic stroke (n=3,680). Level III appropriateness (all indicated medications prescribed) vs. Level 0 appropriateness (none of the indicated medications prescribed) was evaluated on recurrent stroke (HR 0.39, 95% CI 0.18-0.84). Prescribing all indicated secondary prevention medications after noncardioembolic stroke reduced the risk of recurrent stroke compared to prescribing none (HR 0.39; 95% CI 0.18-0.84).