Key result
Prior use of both ACEIs and statins combined with antiplatelets was associated with a 94% reduction in post-stroke in-hospital mortality compared to antiplatelets alone or no medication (p<0.001).
Why the study?
Does adding ACEIs and/or statins to antiplatelets reduce in-hospital mortality in patients with acute ischaemic stroke?
Observational (n=637)
No
Does adding ACEIs and/or statins to antiplatelets reduce in-hospital mortality in patients with acute ischaemic stroke?
Pre-stroke use of ACE inhibitors and statins in combination with antiplatelets is associated with a marked reduction in in-hospital mortality following an acute ischaemic stroke.
Should not yet alter practice in acute ischaemic stroke; hypothesis-generating for randomized trials of pre-stroke ACEI-statin-antiplatelet combinations.
There has been recent interest in combining antiplatelets, angiotensin-converting enzyme inhibitors (ACEIs) and statins in primary and secondary ischaemic stroke prevention. This observational study was performed to evaluate the impact of adding ACEIs and/or statins to antiplatelets on post-stroke in-hospital mortality. Ischaemic stroke patients attending a hospital in Malaysia over an 18-month period were evaluated. Patients were categorized according to their vital status at discharge. Data included demographic information, risk factors, clinical characteristics and previous medications with particular attention on antiplatelets, ACEIs and statins. In-hospital mortality was compared among patients who were not taking antiplatelets, ACEIs or statins before stroke onset versus those who were taking antiplatelets alone or in combination with either ACEIs, statins or both. Data analysis was performed using SPSS version 15. Overall, 637 patients met the study inclusion criteria. After controlling for the effects of confounders, adding ACEIs or statins to antiplatelets significantly decreased the incidence of death after stroke attack by 68% (p = 0.036) and 81% (p = 0.010), respectively, compared to patients on antiplatelets alone or none of these medications. Additionally, the addition of both ACEIs and statins to antiplatelet medication resulted in the highest reduction (by 94%) of the occurrence of death after stroke attack (p < 0.001). Our results suggest that adding ACEIs and/or statins to antiplatelets for patients at risk of developing stroke, either as a primary or as a secondary preventive regimen, was associated with a significant reduction in the incidence of mortality after ischaemic stroke than antiplatelets alone. These results might help reduce the rate of ischaemic stroke morbidity and mortality by enhancing the application of specific therapeutic and management strategies for patients at a high risk of acute stroke.
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Hassan et al. (2011) conducted an observational in Ischaemic stroke (n=637). ACEIs and statins combined with antiplatelets vs. antiplatelets alone or none of these medications was evaluated on in-hospital mortality (94% reduction, p=<0.001). Prior use of both ACEIs and statins combined with antiplatelets was associated with a 94% reduction in post-stroke in-hospital mortality compared to antiplatelets alone or no medication (p<0.001).
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