title: Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly.
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.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA. rkaplan@aecom.yu.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: D L
authors.initials: DL
authors.lastname: Tirschwell
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: T A
authors.initials: TA
authors.lastname: Manolio
authors.forename: S R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: D
authors.initials: D
authors.lastname: Lefkowitz
authors.forename: A
authors.initials: A
authors.lastname: El-Saed
authors.forename: B M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D009026:Mortality; D011446:Prospective Studies; D012008:Recurrence; D012737:Sex Factors; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents