Long-Term Effects of Secondary Prevention on Cognitive Function in Stroke Patients
Background—Limited long-term follow-up data exist on the impact of appropriate secondary prevention therapies on cognitive function in patients after first ever stroke. The aim of this study is to determine the effect of secondary prevention of vascular events on cognitive function after stroke.
Methods and Results—Data were collected between 1995 and 2011 (n=4413) from the community-based South London Stroke Register covering an inner-city multi-ethnic source population of 271,817 inhabitants. Modified Poisson regression models were constructed to adjust for cognitive function status at 3 months, demographic and socioeconomic characteristics, case-mix, stroke subtype, vascular risk factors, disability and stroke recurrence. 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: (i) antihypertensives (relative risk RR: 0.7 [95% confidence interval, 0.57-0.82] for diuretics, RR: 0.8 [0.64-0.98] for angiotensin-converting enzyme inhibitors and RR: 0.7 [0.55-0.81] for the combination of both); (ii) combination of aspirin and dipyridamole (RR: 0.8 [0.68-1.01]); and (iii) statin (RR: 0.9 [0.76-1.06]) when clinically indicated. Protective effects on cognitive impairment were also observed in patients on the combination of antihypertensives, antithrombotic agents and lipid lowering drugs (RR: 0.55 [0.40-0.77]). No significant associations were noted between post-stroke cognitive impairment and antihypertensives among haemorrhagic stroke patients.
Conclusions—Appropriate vascular risk management was associated with a long-term reduced risk of cognitive impairment. Focus on optimal preventive drug therapy of vascular risk factors and management should be supported.
- Received February 24, 2013.
- Revision received July 30, 2013.
- Accepted July 31, 2013.