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Secondary Stroke Prevention After Ischemic Stroke in Patients with Alzheimer's Disease and Other Dementia Disorders

Zupanic, Eva ; Kramberger, Milica G. ; von Euler, Mia ; Norrving, Bo LU ; Winblad, Bengt ; Secnik, Juraj ; Fastbom, Johan ; Eriksdotter, Maria and Garcia-Ptacek, Sara (2020) In Journal of Alzheimer's disease : JAD 73(3). p.1013-1021
Abstract

BACKGROUND: Recurrent ischemic stroke (IS) increases the risk of cognitive decline. To lower the risk of recurrent IS, secondary prevention is essential. OBJECTIVE: Our aim was to compare post-discharge secondary IS prevention and its maintenance up to 3 years after first IS in patients with and without Alzheimer's disease and other dementia disorders. METHODS: Prospective open-cohort study 2007-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who experienced an IS (n = 1410; 332 [23.5%] with Alzheimer's disease) were compared with matched non-dementia IS patients (n = 7150). We analyzed antiplatelet, anticoagulant, blood pressure lowering, and statin... (More)

BACKGROUND: Recurrent ischemic stroke (IS) increases the risk of cognitive decline. To lower the risk of recurrent IS, secondary prevention is essential. OBJECTIVE: Our aim was to compare post-discharge secondary IS prevention and its maintenance up to 3 years after first IS in patients with and without Alzheimer's disease and other dementia disorders. METHODS: Prospective open-cohort study 2007-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who experienced an IS (n = 1410; 332 [23.5%] with Alzheimer's disease) were compared with matched non-dementia IS patients (n = 7150). We analyzed antiplatelet, anticoagulant, blood pressure lowering, and statin treatment as planned medication initiation at discharge and actual dispensation of medications at first, second, and third year post-stroke. RESULTS: At discharge, planned initiation of medication was higher in patients with dementia compared to non-dementia patients for antiplatelets (OR with 95% CI for fully adjusted models 1.23 [1.02-1.48]) and lower for blood pressure lowering medication (BPLM; 0.57 [0.49-0.67]), statins (0.57 [0.50-0.66]), and anticoagulants (in patients with atrial fibrillation - AF; 0.41 [0.32-0.53]). When analysis for antiplatelets was stratified according to the presence of AF, ORs for receiving antiplatelets remained significant only in the presence of AF (in the presence of AF 1.56 [1.21-2.01], in patients without AF 0.99 [0.75-1.33]). Similar trends were observed in 1st, 2nd, and 3rd year post-stroke. CONCLUSIONS: Dementia was a predictor of lower statin and BPLM use. Patients with dementia and AF were more likely to be prescribed antiplatelets and less likely to receive anticoagulants.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer’s disease, anticoagulants, antihypertensive agents, cohort studies, dementia, hydroxymethylglutaryl-CoA reductase inhibitors, ischemic stroke, platelet aggregation inhibitors, secondary prevention
in
Journal of Alzheimer's disease : JAD
volume
73
issue
3
pages
9 pages
publisher
IOS Press
external identifiers
  • pmid:31884483
  • scopus:85079204467
ISSN
1387-2877
DOI
10.3233/JAD-191011
language
English
LU publication?
yes
id
f159b7dd-bc6b-4fb1-a6d2-48c055b0e716
date added to LUP
2020-02-21 14:30:14
date last changed
2024-02-16 11:34:46
@article{f159b7dd-bc6b-4fb1-a6d2-48c055b0e716,
  abstract     = {{<p>BACKGROUND: Recurrent ischemic stroke (IS) increases the risk of cognitive decline. To lower the risk of recurrent IS, secondary prevention is essential. OBJECTIVE: Our aim was to compare post-discharge secondary IS prevention and its maintenance up to 3 years after first IS in patients with and without Alzheimer's disease and other dementia disorders. METHODS: Prospective open-cohort study 2007-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who experienced an IS (n = 1410; 332 [23.5%] with Alzheimer's disease) were compared with matched non-dementia IS patients (n = 7150). We analyzed antiplatelet, anticoagulant, blood pressure lowering, and statin treatment as planned medication initiation at discharge and actual dispensation of medications at first, second, and third year post-stroke. RESULTS: At discharge, planned initiation of medication was higher in patients with dementia compared to non-dementia patients for antiplatelets (OR with 95% CI for fully adjusted models 1.23 [1.02-1.48]) and lower for blood pressure lowering medication (BPLM; 0.57 [0.49-0.67]), statins (0.57 [0.50-0.66]), and anticoagulants (in patients with atrial fibrillation - AF; 0.41 [0.32-0.53]). When analysis for antiplatelets was stratified according to the presence of AF, ORs for receiving antiplatelets remained significant only in the presence of AF (in the presence of AF 1.56 [1.21-2.01], in patients without AF 0.99 [0.75-1.33]). Similar trends were observed in 1st, 2nd, and 3rd year post-stroke. CONCLUSIONS: Dementia was a predictor of lower statin and BPLM use. Patients with dementia and AF were more likely to be prescribed antiplatelets and less likely to receive anticoagulants.</p>}},
  author       = {{Zupanic, Eva and Kramberger, Milica G. and von Euler, Mia and Norrving, Bo and Winblad, Bengt and Secnik, Juraj and Fastbom, Johan and Eriksdotter, Maria and Garcia-Ptacek, Sara}},
  issn         = {{1387-2877}},
  keywords     = {{Alzheimer’s disease; anticoagulants; antihypertensive agents; cohort studies; dementia; hydroxymethylglutaryl-CoA reductase inhibitors; ischemic stroke; platelet aggregation inhibitors; secondary prevention}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{3}},
  pages        = {{1013--1021}},
  publisher    = {{IOS Press}},
  series       = {{Journal of Alzheimer's disease : JAD}},
  title        = {{Secondary Stroke Prevention After Ischemic Stroke in Patients with Alzheimer's Disease and Other Dementia Disorders}},
  url          = {{http://dx.doi.org/10.3233/JAD-191011}},
  doi          = {{10.3233/JAD-191011}},
  volume       = {{73}},
  year         = {{2020}},
}