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Drug therapy post-stroke 'reduces risk of cognitive impairment'

Pharmacological therapy to reduce blood pressure, thrombosis and cholesterol in patients who have had a stroke can reduce the risk of cognitive impairment by up to 45%, suggests a UK study.

 

The study

Researchers looked at data on first-ever strokes in patients of all ages for an inner area of South London. The data were recorded over a 10-year period. Of the 271,817 individuals in the source population, 4,413 individuals had a stroke during the study period. Modified regression models were constructed to adjust for cognitive function status at three months, demographic and socioeconomic characteristics, stroke subtype, vascular risk factors, disability and stroke recurrence.

The results

In patients with ischaemic strokes without history of atrial fibrillation, there was a reduced risk of cognitive impairment associated with the use of different prevention treatments, including antihypertensives, statins, a combination of aspirin and dipyridamole. When compared with patients with ischaemic stroke without history of atrial fibrillation and without treatment, the following antihypertensives reduced cognitive impairment by:  diuretics (30%), ACE inhibitors (20%), combination of diuretics and ACE inhibitors (30%), statins  (10%), aspirin and dipyridamole (20%). Cognitive impairment was reduced by 45% in any type of stroke patient on the combination of antihypertensives, antithrombotic agents and lipid lowering drugs, when compared with patients no taking these treatments. No significant associations were noted between post-stroke cognitive impairment and antihypertensives among haemorrhagic stroke patients.

What this means for GPs

The researchers note that ‘optimal preventative intervention and strategic planning are needed in order for health systems to avert or delay the incidence of cognitive decline progression among stroke survivors’.

JAMA 2013, online 9 Aug

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