Cardiovascular medications and long‐term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA). Issue 9 (3rd August 2022)

• Record Type: Journal Article
• Authors: Souza, Karla AS; Varella, Ana C; Olmos, Rodrigo D; Romagnolli, Carla; Gooden, Tiffany E; Thomas, G Neil; Lip, Gregory YH; Santos, Itamar S; Lotufo, Paulo A; Benseñor, Isabela M; Goulart, Alessandra C
• Is Part Of: Geriatrics and gerontology international. Volume 22:Issue 9(2022)
• Page Start: 715
• Page End: 722
• Publication Date: 2022-08-03
• Subjects: mortality of stroke -- stroke epidemiology -- stroke secondary prevention and medication use; Geriatrics -- Periodicals; Gerontology -- Periodicals; Geriatrics -- Japan -- Periodicals; Gerontology -- Japan -- Periodicals; 618.97
• DOI: 10.1111/ggi.14429
• Languages: English
• ISSNs: 1444-1586

Abstract

Abstract : Aim: To investigate the association between medication use and long‐term all‐cause mortality in a Brazilian stroke cohort. Methods: Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre‐stroke, only post‐stroke, and continuous use. We evaluated anti‐hypertensives, anti‐diabetics, lipid‐lowering drugs, anti‐platelets, and anti‐coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results: Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first‐ever stroke), medication use was low (overall: 17.5% pre‐stroke, 26.4% post‐stroke, and 40% were under continuous use). Anti‐hypertensives and anti‐platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti‐diabetics (31.3%) were the least used. Medication use (pre‐stroke, post‐stroke and continuous use) was associated with a reduction in all‐cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46–0.66) compared with never‐users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40–0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions: The risk of all‐cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; 22: 715–722 .