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Clinical Trial
. 2024 Aug 6;13(15):e034346.
doi: 10.1161/JAHA.124.034346. Epub 2024 Jul 31.

Effect of a Cardiovascular Polypill on Poststroke Cognition Among Ghanaians: Secondary Analysis of a Randomized Clinical Trial

Fred Stephen Sarfo  1   2 , Rexford Adu-Gyamfi  2 , Priscilla Abrafi Opare-Addo  2 , Benedict Agyei  2 , Michael Ampofo  2 , Samuel Blay Nguah  2 , Bruce Ovbiagele  3
Affiliations
Clinical Trial

Effect of a Cardiovascular Polypill on Poststroke Cognition Among Ghanaians: Secondary Analysis of a Randomized Clinical Trial

Fred Stephen Sarfo et al. J Am Heart Assoc. .

Abstract

Background: Poststroke cognitive impairment is prevalent worldwide, with no satisfactory preventative therapeutic strategies. We report on the effect of a cardiovascular polypill on cognitive performance among recent stroke survivors.

Methods and results: The SMAART (Stroke Minimization through Additive Anti-atherosclerotic Agents in Routine Treatment) trial was a phase II randomized trial primarily assessing the polypill versus usual care for secondary prevention after a recent ischemic stroke. Participants allocated to the experimental arm were provided 2 Polycaps taken orally once a day for 12 months. A capsule of Polycap contained aspirin 100 mg, simvastatin 20 mg, hydrochlorothiazide 12.5 mg, ramipril 5 mg, and atenolol 50 mg. Participants in the usual care arm received standard secondary prevention therapy. We compared slopes of the trajectory of raw scores in the executive, language, memory, and visuospatial cognitive domains and aggregated cognitive scores over 12 months via a linear mixed-effects model. We enrolled 148 eligible participants (n=74 in each arm) and 59 versus 64 participants in the polypill and usual care arms, respectively, at month 12. Compared with the usual care arm, the slopes of cognitive performance over 12 months in the polypill arm were steeper by 2.02 units (95% CI, 0.52-3.53), P=0.009 in executive domain, 1.88 units (95% CI, 0.42-3.34), P=0.012 in language domain, 2.60 (0.03-5.17), P=0.049 in memory domain, 0.55 (-0.80 to 1.91), P=0.42 in the visuospatial domain, and global cognitive performance 6.87 units (95% CI, 1.44-12.30), P=0.013.

Conclusions: The cardiovascular polypill is associated with a signal of better cognitive performance over 12 months among stroke survivors. Further definitive trials are warranted.

Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03329599.

Keywords: Africans; cognition; outcomes; polypill; stroke.

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Figures

Figure 1
Figure 1. Consort flow diagram for the SMAART trial.
SMAART indicates Stroke Minimization through Additive Anti‐atherosclerotic Agents in Routine Treatment.
Figure 2
Figure 2
Comparison of trajectory of cognitive domains by study arm.
See this image and copyright information in PMC

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