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Ischemic Stroke and Secondary Prevention in Clinical Practice A Cohort Study of 14 529 Patients in the Swedish Stroke Register

Asberg, Signild; Henriksson, Karin M; Farahmand, Bahman; Asplund, Kjell; Norrving, Bo LU ; Appelros, Peter; Stegmayr, Birgitta; Asberg, Kerstin Hulter and Terent, Andreas (2010) In Stroke: a journal of cerebral circulation 41(7). p.1338-1342
Abstract
Background and Purpose-Secondary prevention is recommended after stroke, but adherence to guidelines is unknown. We studied the prescription of antiplatelet drugs, angiotensin-converting enzyme inhibitors, statins, and anticoagulant drugs and their relation to risk of death. Methods-Patients with first-ever ischemic stroke in 2005 were registered in the Swedish Stroke Register. Odds ratios, hazard ratios, and 95% CIs were calculated using logistic and Cox proportional hazard regression models. Adjustments were performed for age, sex, cardiovascular risk factors, other drug therapies, and activities of daily living function. Results-In total, 14 529 patients with a mean age of 75.0 (+/-11.6) years were included. They were followed for 1.4... (More)
Background and Purpose-Secondary prevention is recommended after stroke, but adherence to guidelines is unknown. We studied the prescription of antiplatelet drugs, angiotensin-converting enzyme inhibitors, statins, and anticoagulant drugs and their relation to risk of death. Methods-Patients with first-ever ischemic stroke in 2005 were registered in the Swedish Stroke Register. Odds ratios, hazard ratios, and 95% CIs were calculated using logistic and Cox proportional hazard regression models. Adjustments were performed for age, sex, cardiovascular risk factors, other drug therapies, and activities of daily living function. Results-In total, 14 529 patients with a mean age of 75.0 (+/-11.6) years were included. They were followed for 1.4 (+/-0.5) years: 52% had hypertension, 26% atrial fibrillation, 19% diabetes, and 15% were smokers. The odds ratio for prescription of antiplatelet was 2.20 (95% CI, 1.86 to 2.60) among the oldest patients (>= 85 years of age) compared with the youngest (18 to 64 years of age). The corresponding odds ratio was 0.38 (0.32 to 0.45) for prescriptions of angiotensin-converting enzyme inhibitors, 0.09 (0.08 to 0.11) for statins, and 0.07 (0.05 to 0.09) for anticoagulant therapy. Prescription of statin and anticoagulant therapy was associated with reduced risk of death (hazard ratio, 0.78 [0.65 to 0.91] and hazard ratio, 0.58 [0.44 to 0.76], respectively) but not the prescription of antiplatelet drugs or angiotensin-converting enzyme inhibitors. Conclusions-The prescription of antiplatelet, angiotensin-converting enzyme inhibitors, statins, and anticoagulant therapy was strongly age related. Statin and anticoagulant therapy was associated with reduced risk of death and seemed to be underused among elderly patients. These findings should encourage physicians to follow today's guidelines for stroke care. (Stroke. 2010;41:1338-1342.) (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
age groups, secondary prevention, cerebral infarction, risk factors
in
Stroke: a journal of cerebral circulation
volume
41
issue
7
pages
1338 - 1342
publisher
American Heart Association
external identifiers
  • wos:000279272200008
  • scopus:77954177552
ISSN
1524-4628
DOI
10.1161/STROKEAHA.110.580209
language
English
LU publication?
yes
id
303017e7-ddf2-4a7c-a6a2-52cf702bf38a (old id 1672570)
date added to LUP
2010-09-23 13:24:35
date last changed
2018-05-29 12:19:47
@article{303017e7-ddf2-4a7c-a6a2-52cf702bf38a,
  abstract     = {Background and Purpose-Secondary prevention is recommended after stroke, but adherence to guidelines is unknown. We studied the prescription of antiplatelet drugs, angiotensin-converting enzyme inhibitors, statins, and anticoagulant drugs and their relation to risk of death. Methods-Patients with first-ever ischemic stroke in 2005 were registered in the Swedish Stroke Register. Odds ratios, hazard ratios, and 95% CIs were calculated using logistic and Cox proportional hazard regression models. Adjustments were performed for age, sex, cardiovascular risk factors, other drug therapies, and activities of daily living function. Results-In total, 14 529 patients with a mean age of 75.0 (+/-11.6) years were included. They were followed for 1.4 (+/-0.5) years: 52% had hypertension, 26% atrial fibrillation, 19% diabetes, and 15% were smokers. The odds ratio for prescription of antiplatelet was 2.20 (95% CI, 1.86 to 2.60) among the oldest patients (>= 85 years of age) compared with the youngest (18 to 64 years of age). The corresponding odds ratio was 0.38 (0.32 to 0.45) for prescriptions of angiotensin-converting enzyme inhibitors, 0.09 (0.08 to 0.11) for statins, and 0.07 (0.05 to 0.09) for anticoagulant therapy. Prescription of statin and anticoagulant therapy was associated with reduced risk of death (hazard ratio, 0.78 [0.65 to 0.91] and hazard ratio, 0.58 [0.44 to 0.76], respectively) but not the prescription of antiplatelet drugs or angiotensin-converting enzyme inhibitors. Conclusions-The prescription of antiplatelet, angiotensin-converting enzyme inhibitors, statins, and anticoagulant therapy was strongly age related. Statin and anticoagulant therapy was associated with reduced risk of death and seemed to be underused among elderly patients. These findings should encourage physicians to follow today's guidelines for stroke care. (Stroke. 2010;41:1338-1342.)},
  author       = {Asberg, Signild and Henriksson, Karin M and Farahmand, Bahman and Asplund, Kjell and Norrving, Bo and Appelros, Peter and Stegmayr, Birgitta and Asberg, Kerstin Hulter and Terent, Andreas},
  issn         = {1524-4628},
  keyword      = {age groups,secondary prevention,cerebral infarction,risk factors},
  language     = {eng},
  number       = {7},
  pages        = {1338--1342},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Ischemic Stroke and Secondary Prevention in Clinical Practice A Cohort Study of 14 529 Patients in the Swedish Stroke Register},
  url          = {http://dx.doi.org/10.1161/STROKEAHA.110.580209},
  volume       = {41},
  year         = {2010},
}