Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly - PubMed (original) (raw)

Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly

R C Kaplan et al. Neurology. 2005.

Erratum in

Neurology. 2006 Feb 28;66(4):493

Abstract

Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged > or =65 years.

Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up.

Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications.

Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

PubMed Disclaimer

Comment in

Cited by

Perioperative management of patients who are receiving a novel oral anticoagulant.
Liew A, Douketis J. Liew A, et al. Intern Emerg Med. 2013 Sep;8(6):477-84. doi: 10.1007/s11739-013-0963-5. Epub 2013 Jun 27. Intern Emerg Med. 2013. PMID: 23807281
The preventing recurrent vascular events and neurological worsening through intensive organized case-management (PREVENTION) trial protocol [clinicaltrials.gov identifier: NCT00931788].
McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Tsuyuki R, Grover SA, Dean N, Shuaib A. McAlister FA, et al. Implement Sci. 2010 Apr 12;5:27. doi: 10.1186/1748-5908-5-27. Implement Sci. 2010. PMID: 20385021 Free PMC article.
Lifestyle Modification for Secondary Stroke Prevention.
Bailey RR. Bailey RR. Am J Lifestyle Med. 2016 Feb 21;12(2):140-147. doi: 10.1177/1559827616633683. eCollection 2018 Mar-Apr. Am J Lifestyle Med. 2016. PMID: 30202386 Free PMC article. Review.
Acetylglutamine Differentially Associated with First-Time Versus Recurrent Stroke.
Kijpaisalratana N, Ament Z, Patki A, Bhave VM, Jones AC, Garcia Guarniz AL, Couch CA, Cushman M, Long DL, Irvin MR, Kimberly WT. Kijpaisalratana N, et al. Transl Stroke Res. 2024 Oct;15(5):941-949. doi: 10.1007/s12975-023-01181-1. Epub 2023 Aug 2. Transl Stroke Res. 2024. PMID: 37531033
Taking care of volunteers in a stroke trial: a new assisted-management strategy.
Stuart AC, Sico JJ, Viscoli CM, Tayal AH, Inzucchi SE, Ford GA, Furie KL, Cote R, Spence JD, Tanne D, Kernan WN. Stuart AC, et al. Stroke Vasc Neurol. 2016 Oct 25;1(3):108-114. doi: 10.1136/svn-2016-000029. eCollection 2016 Sep. Stroke Vasc Neurol. 2016. PMID: 28959471 Free PMC article. Clinical Trial.

Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly - PubMed (original) (raw)