Nastasi, Domenico R., Smith, Justin R., Moxon, Joseph V., Trollope, Alex, and Golledge, Jonathan (2018) Prescription of pharmacotherapy and the incidence of stroke in patients with symptoms of peripheral artery disease. Stroke, 49 (12).

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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 antihypertensive medications (R2=0.94, P<0.01), antiplatelet drugs (R2=0.81, P<0.01), and statins (R2=0.86, P<0.01). 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 antihypertensive drugs, antiplatelet medications, and statins in patients with PAD.

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