title: Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications.
abstract: OBJECTIVE
  To investigate the premorbid use of secondary prevention medications in patients with recurrent vascular events.
  
  
  METHODS
  Prospective, observational, population based study.
  
  
  METHODS
  The Dijon Stroke Registry and the registry of myocardial infarction of Dijon and Côte d'Or, France.
  
  
  METHODS
  All patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attacks) or coronary artery disease (CAD) and a history of vascular disease (cerebral ischaemia, CAD or peripheral arterial disease (PAD)) in Dijon, France from 2006 to 2010.
  
  
  METHODS
  Data on medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predictors of the use of medications.
  
  
  RESULTS
  867 patients (614 cerebral ischaemia and 253 CAD) were recorded including 448 (51.7%) with a history of cerebral ischaemia only, 191 (22.0%) with a history of CAD only, 68 (7.8%) with a history of PAD only and 160 (18.5%) with a history of polyvascular disease. In these 867 patients, 57.3% were on antithrombotic therapy, 61.2% were treated with antihypertensive drugs, 32.9% received statins and only 23.6% were on an optimal regimen, defined as a combination of the three therapies. Compared with patients with previous CAD only, those with previous cerebral ischaemia only were less likely to be receiving each of these treatments or to receive an optimal regimen (OR=0.17, 95% CI 0.14 to 0.26, p<0.001).
  
  
  CONCLUSIONS
  Our findings underline the fact that the underuse of secondary preventive therapies is common in patients with recurrent vascular events, especially those with previous cerebral ischaemia. This underuse could be targeted to reduce recurrent vascular events.
authors.affiliation: Department of Neurology, Dijon Stroke Registry, EA4184, Medical School and University Hospital of Dijon, University of Burgundy, Dijon, France. ybejot@yahoo.fr
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.forename: Odile
authors.initials: O
authors.lastname: Troisgros
authors.forename: Corine
authors.initials: C
authors.lastname: Aboa-Eboulé
authors.forename: Guy-Victor
authors.initials: GV
authors.lastname: Osseby
authors.forename: Maurice
authors.initials: M
authors.lastname: Giroud
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors