Optimal long-term therapy for people who have had ischaemic stroke consists of blood pressure lowering, cholesterol lowering and antiplatelet agents to reduce risk of further cerebrovascular events. Surveys show that guidelines for secondary prevention of cardiovascular (CV) events are not well implemented in clinical practice, especially in elderly patients.
An alternative to traditional ‘treat to target’ approaches is to adopt simpler regimes such as using a fixed dose combination (FDC) pill (otherwise known as a ‘polypill’).
Evidence from trials in other populations, including people at high risk of cardiovascular disease and people with a history of myocardial infarction, suggests that such a regime is at least as effective as standard care. PROPS aims to test whether this strategy, using Trinomia (ramipril, atorvastatin, aspirin), will be as effective as standard care over a period of 25 weeks.
The rationale for such a regime is that it will:
- reduce pill burden
- ensure that all the key pharmacological therapies to lower CV risk after stroke are used
- separate the decision to treat from the underlying level of the risk factor
- reduce monitoring burden (and costs)