Takeaway
- The combined use of 4 or 5 cardiovascular (CV) medications may be optimal for long-term survival in patients with stroke or transient ischaemic attack (TIA).
- Anti-platelet agents (APAs), lipid-regulating medications (LRMs), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) appeared to be optimal constituents of combination therapy associated with a lower risk of mortality after stroke or TIA.
Why this matters
- Findings suggest that multiple pharmacological interventions can provide greater benefits on long-term survival for patients with stroke.
Study design
- This study included 52,619 patients with ischaemic stroke or TIA (age, ≥45 years) from The Health Improvement Network (THIN) database (2007-2016).
- The risk of all-cause mortality was estimated in patients with multiple CV medications vs monotherapy.
- Funding: None.
Key results
- A total of 9230 deaths were recorded during an average follow-up of 3.6 years, 7635 in multiple CV medication groups and 1595 in the monotherapy group.
- Compared with monotherapy, the risk of all-cause mortality was lower with combination therapy (adjusted HR [aHR]; 95% CI):
- 2 medications (0.82; 0.75-0.89);
- 3 medications (0.65; 0.59-0.70);
- 4 medications (0.61; 0.56-0.67);
- 5 medications (0.60; 0.54-0.66); and
- ≥6 medications (0.66; 0.59-0.74).
- The risk of all-cause mortality was lowest in patients with any 4 classes of APAs, LRMs, ACEIs/ARBs, beta-blockers, diuretics and CCBs vs any one class (aHR, 0.51; 95% CI, 0.46-0.57).
- The combination of APAs, LRMs, ACEIs/ARBs and CCBs was associated with a 61% lower risk of mortality vs APAs alone (aHR, 0.39; 95% CI, 0.32-0.47).
Limitations
- Study could not determine if medications were actually dispensed, taken or used in line with the administration directions.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
