Background: Angiotensin-converting enzyme inhibitors
(ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for
ischemic stroke prevention.
Objectives: The objective of the study was to
examine whether previous combination therapy of ACEI with AP and/or statin has
additive effect compared with ACEI alone on functional outcome after ischemic
stroke. Furthermore, factors associated with improving functional outcome were
investigated.
Methods: Ischemic stroke patients attending a Malaysian hospital
in 2008 were categorized according to Barthel Index at discharge. Favorable
outcome was defined as Barthel Index of 75 or greater. Data included
demographic information, clinical characteristics, and previous medications
with particular attention to ACEI, AP, and statin.
Results: Overall, 505
patients were included. Variables associated with good functional outcome were
younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation
infarct stroke subtype (P = 0.034), minor Glasgow
Coma Scale (P < 0.001), and previous use of
ACEI alone or combined with AP and/or statin (P
= 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or
ACEI + AP + statin combinations, there was no significant difference among
combinations on improving functional outcome (P
= 0.852)
Conclusions: Prestroke use of ACEI either alone or combined with AP
and/or statin was associated with better functional outcome. Previous use of
ACEI in combination with AP and/or statin did not significantly differ from
ACEI alone in their effect on outcome. Our study provides a potential rationale
for optimizing the use of ACEI among individuals at risk of developing ischemic
stroke.
Background: Angiotensin-converting enzyme inhibitors (ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for ischemic stroke prevention.
Objectives: The objective of the study was to examine whether previous combination therapy of ACEI with AP and/or statin has additive effect compared with ACEI alone on functional outcome after ischemic stroke. Furthermore, factors associated with improving functional outcome were investigated. Methods: Ischemic stroke patients attending a Malaysian hospital in 2008 were categorized according to Barthel Index at discharge. Favorable outcome was defined as Barthel Index of 75 or greater. Data included demographic information, clinical characteristics, and previous medications with particular attention to ACEI, AP, and statin.
Results: Overall, 505 patients were included. Variables associated with good functional outcome were younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation infarct stroke subtype (P = 0.034), minor Glasgow Coma Scale (P < 0.001), and previous use of ACEI alone or combined with AP and/or statin (P = 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or ACEI + AP + statin combinations, there was no significant difference among combinations on improving functional outcome (P = 0.852).
Conclusions: Prestroke use of ACEI either alone or combined with AP and/or statin was associated with better functional outcome. Previous use of ACEI in combination with AP and/or statin did not significantly differ from ACEI alone in their effect on outcome. Our study provides a potential rationale for optimizing the use of ACEI among individuals at risk of developing ischemic stroke.