Evidence map›Paper›PMID 33530992›Full record

ArticleBMC medicine2021

Impact of multiple cardiovascular medications on mortality after an incidence of ischemic stroke or transient ischemic attack.

Tian-Tian Ma, Ian C K Wong, Cate Whittlesea, Kenneth K C Man, Wallis Lau, Zixuan Wang, Ruth Brauer, Thomas M MacDonald, Isla S Mackenzie, Li Wei

Erratum issuedOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. The effectiveness of bisphosphonates vs denosumab in people with dementia or frailty post hip fracture: a multi-database cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Tian-Tian MaResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Ian C K WongResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Cate WhittleseaResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Kenneth K C ManResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Wallis LauResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Zixuan WangResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Ruth BrauerResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Thomas M MacDonaldMedicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK.
Isla S MackenzieMedicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK.
Li WeiResearch Department of Practice and Policy, School of Pharmacy, University College London, London, UK. l.wei@ucl.ac.uk.
University College London · GBUniversity of Dundee · GBUniversity of Hong Kong · HK

Funding

Medical Research Council G106/1249
6 · The paper itself

Abstract

backgroundTo manage the risk factors and to improve clinical outcomes, patients with stroke commonly receive multiple cardiovascular medications. However, there is a lack of evidence on the optimum combination of medication therapy in the primary care setting after ischemic stroke. Therefore, this study aimed to investigate the effect of multiple cardiovascular medications on long-term survival after an incident stroke event (ischemic stroke or transient ischemic attack (TIA)).

methodsThis study consisted of 52,619 patients aged 45 and above with an incident stroke event between 2007 and 2016 in The Health Improvement Network database. We estimated the risk of all-cause mortality in patients with multiple cardiovascular medications versus monotherapy using a marginal structural model.

resultsDuring an average follow-up of 3.6 years, there were 9230 deaths (7635 in multiple cardiovascular medication groups and 1595 in the monotherapy group). Compared with patients prescribed monotherapy only, the HRs of mortality were 0.82 (95% CI 0.75-0.89) for two medications, 0.65 (0.59-0.70) for three medications, 0.61 (0.56-0.67) for four medications, 0.60 (0.54-0.66) for five medications and 0.66 (0.59-0.74) for ≥ six medications. Patients with any four classes of antiplatelet agents (APAs), lipid-regulating medications (LRMs), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), beta-blockers, diuretics and calcium channel blockers (CCBs) had the lowest risk of mortality (HR 0.51, 95% CI 0.46-0.57) versus any one class. The combination containing APAs, LRMs, ACEIs/ARBs and CCBs was associated with a 61% (95% CI 53-68%) lower risk of mortality compared with APAs alone.

conclusionOur results suggested that combination therapy of four or five cardiovascular medications may be optimal to improve long-term survival after incident ischemic stroke or TIA. APAs, LRMs, ACEIs/ARBs and CCBs were the optimal constituents of combination therapy in the present study.

Indexed as

Adrenergic beta-AntagonistsAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsBrain IschemiaCalcium Channel BlockersHumansIncidenceIschemic Attack, TransientIschemic StrokeMaleMiddle AgedAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCalcium Channel BlockersCohort studyCombination drug therapyMortalityStroke

Identifiers

PMID33530992
PMCPMC7856718
OpenAlexW3128439271

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.