ArticlePLoS medicine2016
Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis.
Article in PLoS medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review.PloS one · 2024Pooled it
- Associations between lifestyle and initiation of cardiovascular preventive medicines in 60-year-olds at low to moderate cardiovascular risk level - a prospective cohort study based on the VIPVIZA-trial.BMC cardiovascular disorders · 2026Trial
- Prescription of Lipid-Lowering and Antihypertensive Drugs Following Pictorial Information About Subclinical Atherosclerosis: A Secondary Outcome of a Randomized Clinical Trial.JAMA network open · 2021Trial
- Optimisation of oral anticoagulation for stroke prevention: a scoping review of factors influencing implementation.BMJ open · 2025Article
- Country and health expenditure are major predictors of withholding anticoagulation in atrial fibrillation patients at high risk of stroke.Open heart · 2023Article
- The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: Results from the VIPVIZA randomized clinical trial.American journal of preventive cardiology · 2021Article
- Primary Prevention of Cardiovascular Risk in Lithuania-Results from EUROASPIRE V Survey.Medicina (Kaunas, Lithuania) · 2020Observational
- The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients.Risk management and healthcare policy · 2020Article
- Lipid-lowering drug prescriptions in a group of Colombian patients.Biomedica : revista del Instituto Nacional de Salud · 2019Article
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- Underuse of anticoagulation therapy for atrial fibrillation: Are we failing our patients?Canadian family physician Medecin de famille canadien · 2017Article
- Overtreatment and undertreatment: time to challenge our thinking.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundStroke is a leading cause of death and disability; worldwide it is estimated that 16.9 million people have a first stroke each year. Lipid-lowering, anticoagulant, and antihypertensive drugs can prevent strokes, but may be underused. METHODS AND
findingsWe analysed anonymised electronic primary care records from a United Kingdom (UK) primary care database that covers approximately 6% of the UK population. Patients with first-ever stroke/transient ischaemic attack (TIA), ≥18 y, with diagnosis between 1 January 2009 and 31 December 2013, were included. Drugs were considered under-prescribed when lipid-lowering, anticoagulant, or antihypertensive drugs were clinically indicated but were not prescribed prior to the time of stroke or TIA. The proportions of strokes or TIAs with prevention drugs under-prescribed, when clinically indicated, were calculated. In all, 29,043 stroke/TIA patients met the inclusion criteria; 17,680 had ≥1 prevention drug clinically indicated: 16,028 had lipid-lowering drugs indicated, 3,194 anticoagulant drugs, and 7,008 antihypertensive drugs. At least one prevention drug was not prescribed when clinically indicated in 54% (9,579/17,680) of stroke/TIA patients: 49% (7,836/16,028) were not prescribed lipid-lowering drugs, 52% (1,647/3,194) were not prescribed anticoagulant drugs, and 25% (1,740/7,008) were not prescribed antihypertensive drugs. The limitations of our study are that our definition of under-prescribing of drugs for stroke/TIA prevention did not address patients' adherence to medication or medication targets, such as blood pressure levels.
conclusionsIn our study, over half of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. We estimate that approximately 12,000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs. Improving prescription of lipid-lowering, anticoagulant, and antihypertensive drugs is important to reduce the incidence and burden of stroke and TIA.
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