title: Optimal combination treatment and vascular outcomes in recent ischemic stroke patients by premorbid risk level.
abstract: BACKGROUND
  Optimal combination of secondary stroke prevention treatment including antihypertensives, antithrombotic agents, and lipid modifiers is associated with reduced recurrent vascular risk including stroke. It is unclear whether optimal combination treatment has a differential impact on stroke patients based on level of vascular risk.
  
  
  METHODS
  We analyzed a clinical trial dataset comprising 3680 recent non-cardioembolic stroke patients aged ≥35 years and followed for 2 years. Patients were categorized by appropriateness levels 0 to III depending on the number of the drugs prescribed divided by the number of drugs potentially indicated for each patient (0=none of the indicated medications prescribed and III=all indicated medications prescribed [optimal combination treatment]). High-risk was defined as having a history of stroke or coronary heart disease (CHD) prior to the index stroke event. Independent associations of medication appropriateness level with a major vascular event (stroke, CHD, or vascular death), ischemic stroke, and all-cause death were analyzed.
  
  
  RESULTS
  Compared with level 0, for major vascular events, the HR of level III in the low-risk group was 0.51 (95% CI: 0.20-1.28) and 0.32 (0.14-0.70) in the high-risk group; for stroke, the HR of level III in the low-risk group was 0.54 (0.16-1.77) and 0.25 (0.08-0.85) in the high-risk group; and for all-cause death, the HR of level III in the low-risk group was 0.66 (0.09-5.00) and 0.22 (0.06-0.78) in the high-risk group.
  
  
  CONCLUSIONS
  Optimal combination treatment is related to a significantly lower risk of future vascular events and death among high-risk patients after a recent non-cardioembolic stroke.
authors.affiliation: Department of Neurology, Seonam University Myongji Hospital, Goyang, South Korea; Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, SC, United States. Electronic address: Ovibes@musc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents
keywords: Death; Drug; High-risk; Secondary prevention; Stroke; Vascular events