Impact of age and sex on primary preventive treatment for cardiovascular disease in the West Midlands, UK: cross sectional study

Sheppard, James P; Singh, Surendra Prasad; Fletcher, Kate; McManus, Richard J; Mant, Jonathan

doi:10.1136/bmj.e4535

Cited by 56 publications

(35 citation statements)

References 36 publications

(61 reference statements)

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“…UK research found significantly lower primary prevention use among older people, despite advancing age being the most important risk factor for vascular disease. 19 The SLSR did not record contraindications to anticoagulants, although US research found low warfarin use even among those with no contraindications. 6 These results provide an example of delay in implementing evidence-based practice.…”

Section: Discussionmentioning

confidence: 99%

Trends in Risk Factor Prevalence and Management Before First Stroke

Marshall

Wang

McKevitt

et al. 2013

Stroke

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Stroke remains a major preventable cause of morbidity and mortality internationally.1 In addition to lifestyle modification, cost-effective drug treatments for hypertension, hypercholesterolemia, and atrial fibrillation (AF) reduce stroke risk, heart disease, and mortality. [2][3][4] Despite international guidance aimed at improving primary prevention, risk factor control rates remain low. [5][6][7] Suboptimal control is associated with inadequate risk factor detection and treatment, ethnic differences in risk factor susceptibility and response to treatment, socioeconomic deprivation, and poor treatment adherence. 5,[7][8][9] Several studies have found ethnic differences in stroke risk factors. A US case-control study found that hypertension and diabetes mellitus were significantly more prevalent among black than white patients with stroke, whereas AF was significantly more prevalent in white patients.10 Similar results were reported by the South London Stroke Register (SLSR) from 1995 to 1998. 11 A US cross-sectional study found that apparent ethnic differences in stroke risk factors were explained by differences in income. 12 We sought to examine trends from 1995 to 2011 in beforestroke risk factors and use of appropriate treatment, using data from the SLSR. We aimed to investigate variation in risk factors by age, sex, ethnicity, socioeconomic group, and stroke subtype, and factors associated with appropriate treatment. MethodsThe methods of the SLSR have been described previously 13 and are summarized below. The SLSR is a population-based register recording all first strokes in a defined region of Lambeth and Southwark, with a population of 310 028 according to the 2001 UK Census, with 63% white, 28% black (9% black Caribbean, 15% black African, and 4% black other), and 9% other ethnic group. By 2011, the source population had increased to 357 308, with 56% white, 25% black (7% black Caribbean, 14% black African, 4% black other), and 18% other.Background and Purpose-Vascular risk factors are suboptimally managed internationally. This study investigated time trends in risk factors diagnosed before stroke and their treatment, and factors associated with appropriate medication use. Methods-A total of 4416 patients with a first stroke were registered in the population-based South London Stroke Register from 1995 to 2011. Previously diagnosed risk factors and usual medications were collected from patients' primary care and hospital records. Trends and associations were assessed using multivariate logistic regression. Results-Seventy-two percent of patients were diagnosed previously with 1 or more risk factors; 30% had diagnosed risk factors that were untreated. Hypercholesterolemia increased significantly during the study period; myocardial infarction and transient ischemic attack prevalences decreased. [TIA], and diabetes mellitus) and usual prescribed medication (antiplatelets, anticoagulants, antihypertensive drugs, and cholesterol-lowering drugs) were collected from patients' general practitioners and hospit...

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Section: Discussionmentioning

confidence: 99%

Trends in Risk Factor Prevalence and Management Before First Stroke

Marshall

Wang

McKevitt

et al. 2013

Stroke

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“…37 The data support the findings of previous studies that examined the association between age and sex, and prescription of medication for the primary prevention of CVD. 38 In primary prevention, the study showed that younger patients and females are more likely to be prescribed therapy, despite all eligible patients being at high risk of developing CVD by definition. This is interesting and does not suggest that GP prescribing practice is solely based on calculated 10-year CVD risk.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study

et al. 2013

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“…It is the level of severity of the chronic disease and its associated complications which are actually costly (9,27). This highlights the importance of promoting prevention at all ages (including after age 60 years) to reduce the impact and cost of NCDs (28)(29)(30)(31)(32)(33)(34)(35). Given that every 10% increase in NCDs is estimated to lower annual economic growth by 0.5% (20), the need for NCD prevention, especially in the rapidly growing older population, is substantial.…”

Section: Introductionmentioning

confidence: 99%