Abstract T P392: Optimal Combination Secondary Prevention Drug Treatment and Stroke Outcomes

Abstract

Background: Over the last decade there has been a documented decline in the stroke incidence and mortality in several developed nations around the world, which is thought to be due mainly to better treatment of traditional risk factors for stroke. It has been suggested that optimal combination(s) of individually proven secondary prevention drug classes, could reduce recurrent vascular events. However, the effect of combining antihypertensive agents (AH), lipid modifiers (LM), and antithrombotic agents (AT) on outcomes after stroke has not previously been studied. Methods: We analyzed the database of a multicenter trial involving 3680 recent ischemic stroke patients aged ≥35 years and followed for 2 years. Patients were categorized by appropriateness level 0 to III depending on the number of the drugs prescribed divided by the number of the 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 (CHD)/vascular death (secondary outcome), and all-cause 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 to level 0: the adjusted hazard ratio (AHR) of stroke for level I was (0.51, 95% CI, 0.21–1.25), level II 0.50 (0.23–1.09), and level III 0.39 (0.18–0.84); of stroke/CHD/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); of all-cause 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). Interpretation: Optimal combination prescription of secondary prevention medication was associated with an independent lower risk of stroke, stroke/CHD/vascular death, and all-cause death in recent stroke patients over a 2 year follow-up period. While future studies are certainly warranted to confirm/disconfirm our findings, clinicians may want to ensure that for eligible recent stroke patients, all appropriate secondary prevention drug classes are prescribed and maintained.