Optimal combination secondary prevention drug treatment and stroke outcomes.
- Authors
- Park, Jong-Ho; Ovbiagele, Bruce
- Issue Date
- Jan-2015
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Citation
- NEUROLOGY, v.84, no.1, pp.50 - 56
- Indexed
- SCIE
SCOPUS
- Journal Title
- NEUROLOGY
- Volume
- 84
- Number
- 1
- Start Page
- 50
- End Page
- 56
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/158048
- DOI
- 10.1212/WNL.0000000000001099
- ISSN
- 0028-3878
- Abstract
- 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).
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