Prescription of Pharmacotherapy and the Incidence of Stroke in Patients With Symptoms of Peripheral Artery Disease

Domenico R Nastasi; Justin R Smith; Joseph V Moxon; Alexandra Trollope; Jonathan Golledge

doi:10.1161/STROKEAHA.118.022922

Prescription of Pharmacotherapy and the Incidence of Stroke in Patients With Symptoms of Peripheral Artery Disease

Stroke. 2018 Dec;49(12):2953-2960. doi: 10.1161/STROKEAHA.118.022922.

Authors

Domenico R Nastasi^{1

2}, Justin R Smith^{1

2}, Joseph V Moxon^{1

2}, Alexandra Trollope^{1

3

2}, Jonathan Golledge^{1

2

4}

Affiliations

¹ From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.
² College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.
³ Discipline of Anatomy (A.T.), James Cook University, Townsville, QLD, Australia.
⁴ Department of Vascular and Endovascular Surgery, The Townsville Hospital, QLD, Australia (J.G.).

PMID: 30571405
DOI: 10.1161/STROKEAHA.118.022922

Abstract

Background and Purpose- Current guidelines recommend prescription of a number of medications to prevent cardiovascular events in patients with peripheral artery disease (PAD). The impact that these medications have on the incidence of stroke in PAD patients has not been thoroughly investigated. This study aimed to investigate the association of prescription of antihypertensive drugs, antiplatelet medications, and statins, as well as cardiovascular disease risk factors, with stroke incidence in patients with symptoms of PAD. Methods- A database search was completed to identify studies reporting the incidence of stroke and prescription of antihypertensive drugs, antiplatelet medications, and statins in patients with PAD symptoms. A random-effects model was used to meta-analyze the incidence of stroke in patients with symptoms of PAD and in subgroups with intermittent claudication and critical limb ischemia. Metaregression was performed to explore the association between the incidence of stroke and the prescription of medications and the presence of cardiovascular disease risk factors. Results- Twelve studies including 67 915 patients with symptoms of PAD were included. A meta-analysis of data from 7 studies demonstrated an incidence of stroke of 1.31 per 100 patient-years. Patients with critical limb ischemia experienced stroke 2.3× more frequently than those with intermittent claudication (95% CI, 1.58-3.36; P<0.01). The reported prescription of antihypertensive agents varied between 10% and 71%, antiplatelet drugs between 49% and 90%, and statins between 11% and 79% in different studies. Metaregression suggested an association between a lower incidence of stroke and the prescription of antiplatelet drugs ( R²=0.81, P<0.01), and statins ( R²=0.85, P<0.01), but not antihypertensives medications. A prior history of cerebrovascular events was associated with a higher incidence of stroke ( R²=0.58, P<0.05). Conclusions- This review supports previous research which suggests the need for more effective means of ensuring more widespread prescription of preventative medications in patients with PAD.

Keywords: atherosclerosis; incidence; meta-analysis; peripheral artery disease; stroke.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Antihypertensive Agents / therapeutic use*
Cardiovascular Diseases / drug therapy
Cardiovascular Diseases / epidemiology
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Incidence
Peripheral Arterial Disease / drug therapy*
Peripheral Arterial Disease / epidemiology
Platelet Aggregation Inhibitors / therapeutic use*
Regression Analysis
Secondary Prevention
Stroke / epidemiology*

Substances

Antihypertensive Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors