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Title: Is prestroke use of angiotensin-converting enzyme inhibitors associated with better outcome?
Austin Authors: Chitravas, N;Dewey, Helen M;Nicol, M B;Harding, D L;Pearce, D C;Thrift, Amanda G
Affiliation: National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia
Issue Date: 15-May-2007
Publication information: Neurology; 68(20): 1687-93
Abstract: There is evidence that angiotensin-converting enzyme inhibitors (ACEIs) reduce the risk of stroke. However, it is unclear whether ACEI use before stroke provides a vasoprotective effect resulting in less severe stroke.We ascertained all strokes occurring in a defined population in Melbourne, Australia. Prestroke use of ACEIs and concomitant medications was obtained from medical records. Initial neurologic deficit was dichotomized according to a NIH Stroke Scale (NIHSS) score < 8 (less severe deficit) or > or = 8 (severe deficit). Logistic regression was used to assess the association between prestroke use of ACEIs and stroke severity (measured by severity of neurologic deficits and death at 28 days).Seven hundred sixteen first-ever ischemic stroke patients were included. Previous use of ACEIs was independently associated with a reduced risk of severe neurologic deficits (odds ratio [OR] 0.56; 95% CI 0.35 to 0.91) and death within 28 days (OR 0.46; 95% CI 0.24 to 0.87). Diuretics were associated with an increased risk of severe neurologic deficits (OR 1.81; 95% CI 1.13 to 2.90). Factors associated with a greater NIHSS score were older age, atrial fibrillation, heart failure, and use of diuretics. These factors and claudication were associated with an increased risk of 28-day mortality, whereas use of anticoagulants was associated with a reduced risk of severe neurologic deficits and death.Within this large community-based cohort, prestroke use of angiotensin-converting enzyme inhibitors was associated with a reduced risk of severe stroke.
Gov't Doc #: 17502550
DOI: 10.1212/01.wnl.0000261914.18101.60
Journal: Neurology
Type: Journal Article
Subjects: Aged
Angiotensin-Converting Enzyme Inhibitors.therapeutic use
Anticoagulants.therapeutic use
Antihypertensive Agents.therapeutic use
Brain Damage, Chronic.epidemiology.etiology.prevention & control
Brain Ischemia.complications.epidemiology.mortality
Cardiovascular Diseases.drug therapy.epidemiology
Cohort Studies
Confounding Factors (Epidemiology)
Diuretics.therapeutic use
Hydroxymethylglutaryl-CoA Reductase Inhibitors.therapeutic use
Middle Aged
Odds Ratio
Platelet Aggregation Inhibitors.therapeutic use
Risk Factors
Severity of Illness Index
Survival Analysis
Time Factors
Appears in Collections:Journal articles

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