Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. kdp @ dce.au.dk
Cerebrovasc Dis. 2010;30(6):556-66. doi: 10.1159/000319030. Epub 2010 Oct 14.
The extent and implications of age- and sex-related differences in prophylaxis following ischemic stroke are unknown. We examined differences in the use of medical prophylaxis across age and sex groups in stroke patients after hospital discharge in Denmark and estimated the possible impact on age- and sex-related differences in mortality.
A nationwide population-based follow-up study was conducted involving 28,634 patients hospitalized for ischemic stroke in 2003-2006 who survived 30 days after discharge. The proportion of patients who filled prescriptions for cardiovascular drugs within 0-6 and 12-18 months after discharge was determined. Mortality rates were compared across age and sex groups with and without controlling for use of medical prophylaxis.
Increasing age was associated with lower prophylaxis. Adjusted odds ratios for the use of a combination of a platelet inhibitor, an antihypertensive and a statin were 0.45 [95% confidence interval (CI): 0.38-0.54] and 0.52 (95% CI: 0.43-0.62) for men and women >80 years, respectively, compared with men ≤65 years. No systematic sex-related differences were identified. Continued drug use ranged from 66.1 to 91.9% for different drugs 12-18 months after discharge, with the lowest rate of continued use found among patients >80 years. Controlling for use of medical prophylaxis was associated with lower mortality rate ratios for elderly compared with younger patients.
Continuous efforts are warranted to ensure implementation of evidence-based secondary prophylaxis among elderly patients with ischemic stroke.
目前尚不清楚缺血性脑卒中后预防措施在年龄和性别方面的差异程度和意义。我们研究了丹麦出院后脑卒中患者在年龄和性别组之间使用医学预防措施的差异，并估计了这对死亡率的年龄和性别相关差异的可能影响。
进行了一项全国性的基于人群的随访研究，共纳入 2003-2006 年因缺血性脑卒中住院且出院后 30 天存活的 28634 例患者。确定了出院后 0-6 个月和 12-18 个月内患者服用心血管药物的比例。在未控制和控制医学预防措施使用的情况下，比较了不同年龄和性别组的死亡率。
随着年龄的增加，预防措施的应用率降低。与≤65 岁的男性相比，年龄>80 岁的男性和女性使用血小板抑制剂、降压药和他汀类药物联合治疗的调整比值比分别为 0.45（95%置信区间：0.38-0.54）和 0.52（95%置信区间：0.43-0.62）。未发现系统性的性别差异。出院后 12-18 个月，不同药物的持续用药率为 66.1%-91.9%，其中>80 岁患者的持续用药率最低。控制医学预防措施的使用与老年患者的死亡率比值比低于年轻患者相关。
需要持续努力确保为老年缺血性脑卒中患者实施基于证据的二级预防。
