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

Abstract

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: 0.20-1.28) and 0.32 (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 0.25 (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 0.22 (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.

Keywords: Death; Drug; High-risk; Secondary prevention; Stroke; Vascular events.

Fig. 1

Two-year vascular outcome events and all-cause death after a recent stroke (<120 days) by low- and high-risk groups. High-risk is defined as history of stroke or coronary heart disease.

Fig. 2

Kaplan-Meier curves for the endpoint of major vascular events (A) and stroke (B) over 2 years in the high-risk* group after an ischemic stroke based on secondary prevention medication classes (level 0 to III). Optimal combination drug treatment as level III diminishes risk of vascular events. * Defined as history of stroke or coronary heart disease.

Fig. 3

Kaplan-Meier curves for the endpoint of all-cause death over 2 years in the high-risk* group after an ischemic stroke based on secondary prevention medication classes (level 0 to III). Optimal combination drug treatment as level III reduces risk of death. * Defined as history of stroke or coronary heart disease.