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Journal of Public Health Advance Access published online on June 21, 2007
Journal of Public Health, doi:10.1093/pubmed/fdm040
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Missed opportunities for secondary prevention of cerebrovascular disease in elderly British men from 1999 to 2005: a population-based study


Sheena E. Ramsay, MRC Special Training Fellow in Health of the Public and Health Services Research1,
Peter H. Whincup, Professor of Cardiovascular Epidemiology2
S. G. Wannamethee, Reader in Epidemiology1
Olia Papacosta, Research Statistician1
Lucy Lennon, Research Administrator1
Mary C. Thomas, Research Assistant1
Richard W. Morris, Reader in Medical Statistics and Epidemiology1

1 Department of Primary Care and Population Sciences, Royal Free and University College Medical School, UCL Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK
2 Department of Community Health Sciences, St George's, University of London, London SW17 0RE, UK


Address correspondence to Sheena E. Ramsay, E-mail: s.ramsay{at}pcps.ucl.ac.uk


  Abstract

Objective We examined patterns in medication use for secondary prevention of cerebrovascular disease in older British men from 1999 to 2005, and investigated socio-demographic and disease-related influences on medication use.

Methods Percentage use of antiplatelet drugs, blood pressure-lowering drugs and statins use was calculated in men, aged 65–87 years in 2005, who had been diagnosed with stroke or transient ischaemic attack (TIA) from a population-based cohort based in one general practice in each of 24 British towns.

Results In 1999, most men with cerebrovascular disease received antiplatelet drugs (67%). However, a few received blood pressure-lowering drugs (50%) and statins (13%). By 2005, the use of all drug types had increased; at least half of the patients received each type of drug. However, only one-third of patients received all three medication types and combined blood pressure treatment was limited. Older age, a diagnosis of TIA rather than stroke and absence of co-existing coronary heart disease were associated with lower rates of use of specific medication categories.

Conclusion Despite improvements in secondary prevention medication use, there is scope for achieving the full potential of these medications, particularly by increasing combination blood pressure treatment and statin use and ensuring that older patients receive the benefits of prevention.

Keywords: cerebrovascular disease, medication use, secondary prevention


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