Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA)

NIHR Global Health Research Group on Atrial Fibrillation Management

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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; ••: ••-••.

Original languageEnglish
Pages (from-to)715-722
Number of pages8
JournalGeriatrics & gerontology international
Volume22
Issue number9
Early online date3 Aug 2022
DOIs
Publication statusPublished - Sept 2022

Bibliographical note

Funding Information:
This study was funded by the Sao Paulo Research Support Foundation of the State of São Paulo (FAPESP) (grant no. 2018/05512–3) and by the NIHR Global Health Research Group on AF (grant no. 17/63/121).

Publisher Copyright:
© 2022 Japan Geriatrics Society.

Keywords

  • mortality of stroke
  • stroke epidemiology
  • stroke secondary prevention and medication use

ASJC Scopus subject areas

  • Health(social science)
  • Geriatrics and Gerontology
  • Gerontology

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