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Expert Opinion on Investigational Drugs Volume 13, 2004 - Issue 12
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Review

Novel therapies for the prevention of stroke

Christopher J Boos Southampton General Hospital, Department of Cardiology, UK. [email protected]
&
Gregory YH Lip Southampton General Hospital, Department of Cardiology, UK. [email protected]
Pages 1615-1630 | Published online: 24 Feb 2005

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  • •This is a highly authoritative up-to-date article outlining the uses and characteristics of ximelagatran.
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  • •The MATCH study highlighted the important potential haemorrhagic side effects of an aspirin-clopidogrel combination in secondary stroke prevention, with only modest apparent benefit.
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  • •A historically important paper. However, the results of recent trials, such as LIFE, HOPE and EUROPA, have challenged the cental doctrine of this paper, to suggest that the way blood pressure is lowered is critically important.
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  • YUSUF S, PEPINE CJ, GARCES C et al: Effects of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions. Lancet (1992) 340:1173-1178. ma PFEFFER MA, BRAUNWALD E, MOYE LA et al.: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl. J. Med. (1992) 327:669–677.
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  • ••HOPE is a landmark paper, which hassignificantly influenced clinical practice. Along with the EUROPA study, it supports the use of an ACE inhibitor in patients at high risk of future cardiovascular endpoints even in the absence of LV dysfunction.
  • Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. PROGRESS Collaborative Group. Lancet (2001) 358:1033–1041.
  • ••The HOPE study is a landmark paperdemonstrating the impressive benefits of the ACE inhibitor ramipril and its ability to reduce important clinical end points (including stroke) among a large cohort of high-risk patients. The benefits of ramipril seem to be independent of blood pressure reduction.
  • BLANN AD, NADAR S, LIP GYH: Pharmacological modulation of platelet function in hypertension. Hypertension (2003) 42:1–7.
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  • ••The LIFE study demonstrated that the wayin which blood pressure is lowered may be critically important in stroke prevention.
  • SCHRADER J: Morbidity and Mortality After Stroke: Eprosartan versus Nitrendipine in Secondary Prevention (MOSES). Proceedings of the European Socieg, of Cardiology Congress, Munich, Germany (2004).
  • •This further supports data from LIFE demonstrating the benefits of ARBs in stroke prevention and suggests benefits beyond simple blood pressure reduction.
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  • •This paper has the potential to significantly influence medical practice.
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  • •This paper has the potential to significantly influence medical practice.
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  • •This is a highly informative paper outlining the important properties of omega-3 fatty acid, as well as giving an overview of the pertinent clinical trials involving their use.
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  • ••This is the only randomised trial to assessthe efficacy of omega-3 fatty acids in secondary prevention post-MI. 102. GALAN P, DE BREE A, MENNEN L et al.: Background and rationale of the SU.FOL0M3 study: double-blind randomized placebo-controlled secondary prevention trial to test the impact of supplementation with folate, vitamin B6 and B12 and/or omega-3 fatty acids on the prevention of recurrent ischemic events in subjects with atherosclerosis in the coronary or cerebral arteries. Nutr. Health Aging. (2003) 7:428–435.
  • •One of the two ongoing large, double-blind, randomised studies that are looking into the effects of homocysteine-lowering therapy on the secondary prevention of stroke and cardiovascular outcomes.
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  • •A key paper that has demonstrated that elevated total homocysteine levels are associated with increased risk of stroke and coronary disease.
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  • ••A key paper demonstrating that elevatedtotal homocysteine levels are associated with increased risk of stroke and coronary disease.
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  • •Important studies that assess the impact of homocysteine-lowering therapy (in an
  • Expert Op/n. lnvestig. Drugs (2004) 13(12) observational manner) on cardiovascular outcomes with inconsistent results. It highlights the need for randomised studies on homocysteine-lowering therapy.
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  • •Important studies that assess the impact of homocysteine-lowering therapy (in an observational manner) on cardiovascular outcomes with inconsistent results. It highlights the need for randomised studies on homocysteine-lowering therapy.
  • The VITATOPS (Vitamins to Prevent Stroke) Trial: rationale and design of an international, large, simple, randomised trial of homocysteine-lowering multivitamin therapy in patients with recent transient ischaemic attack or stroke. VITATOPS Trial Study Group. Cerebrovasc. D AK (2002) 13:120–126.
  • •One of the two ongoing large, double-blind, randomised studies that are looking into the effects of homocysteine-lowering therapy on the secondary prevention of stroke and cardiovascular outcomes.
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