Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly

Robert C. Kaplan, D. L. Tirschwell, W. T. Longstreth, T. A. Manolio, S. R. Heckbert, D. Lefkowitz, A. El-Saed, B. M. Psaty

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged ≥65 years. Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up. Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications. Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

Original languageEnglish (US)
Pages (from-to)835-842
Number of pages8
JournalNeurology
Volume65
Issue number6
DOIs
StatePublished - Sep 27 2005

Fingerprint

Blood Vessels
Stroke
Mortality
Coronary Disease
Therapeutics
Recurrence
Heart Rate
Blood Pressure
Lacunar Stroke
Platelet Aggregation Inhibitors
Warfarin
Atrial Fibrillation
Aspirin
Uncertainty
Clinical Trials
Lipids
Drug Therapy
Health
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Kaplan, R. C., Tirschwell, D. L., Longstreth, W. T., Manolio, T. A., Heckbert, S. R., Lefkowitz, D., ... Psaty, B. M. (2005). Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology, 65(6), 835-842. https://doi.org/10.1212/01.wnl.0000176058.09848.bb

Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. / Kaplan, Robert C.; Tirschwell, D. L.; Longstreth, W. T.; Manolio, T. A.; Heckbert, S. R.; Lefkowitz, D.; El-Saed, A.; Psaty, B. M.

In: Neurology, Vol. 65, No. 6, 27.09.2005, p. 835-842.

Research output: Contribution to journalArticle

Kaplan, RC, Tirschwell, DL, Longstreth, WT, Manolio, TA, Heckbert, SR, Lefkowitz, D, El-Saed, A & Psaty, BM 2005, 'Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly', Neurology, vol. 65, no. 6, pp. 835-842. https://doi.org/10.1212/01.wnl.0000176058.09848.bb
Kaplan RC, Tirschwell DL, Longstreth WT, Manolio TA, Heckbert SR, Lefkowitz D et al. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology. 2005 Sep 27;65(6):835-842. https://doi.org/10.1212/01.wnl.0000176058.09848.bb
Kaplan, Robert C. ; Tirschwell, D. L. ; Longstreth, W. T. ; Manolio, T. A. ; Heckbert, S. R. ; Lefkowitz, D. ; El-Saed, A. ; Psaty, B. M. / Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. In: Neurology. 2005 ; Vol. 65, No. 6. pp. 835-842.
@article{0f8c5c95e9e840fa93462ed199e08f10,
title = "Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly",
abstract = "Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged ≥65 years. Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up. Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8{\%} used aspirin and 13.5{\%} used other antiplatelet agents; 52.6{\%} of patients with atrial fibrillation used warfarin; 31.3{\%} of hyperlipidemic subjects, 57.0{\%} of diabetic patients, and 81.5{\%} of hypertensive patients were drug-treated; and 40.0{\%} of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications. Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.",
author = "Kaplan, {Robert C.} and Tirschwell, {D. L.} and Longstreth, {W. T.} and Manolio, {T. A.} and Heckbert, {S. R.} and D. Lefkowitz and A. El-Saed and Psaty, {B. M.}",
year = "2005",
month = "9",
day = "27",
doi = "10.1212/01.wnl.0000176058.09848.bb",
language = "English (US)",
volume = "65",
pages = "835--842",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly

AU - Kaplan, Robert C.

AU - Tirschwell, D. L.

AU - Longstreth, W. T.

AU - Manolio, T. A.

AU - Heckbert, S. R.

AU - Lefkowitz, D.

AU - El-Saed, A.

AU - Psaty, B. M.

PY - 2005/9/27

Y1 - 2005/9/27

N2 - Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged ≥65 years. Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up. Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications. Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

AB - Background: The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults aged ≥65 years. Methods: The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up. Results: During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP) <140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP <140/90 mm Hg, and low-income subjects were less likely to use diabetes medications. Conclusions: Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

UR - http://www.scopus.com/inward/record.url?scp=25444492424&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25444492424&partnerID=8YFLogxK

U2 - 10.1212/01.wnl.0000176058.09848.bb

DO - 10.1212/01.wnl.0000176058.09848.bb

M3 - Article

VL - 65

SP - 835

EP - 842

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 6

ER -