Drugs used for heart conditions linked to improved outcomes for stroke patients

Drugs commonly used to treat heart and circulatory diseases could be given to patients who have had strokes linked to cases of dementia, a trial has shown.

Medicines such as mononitrate and cilostazol can safely improve outcomes in those who have had a lacunar stroke, the trial led by the universities of Edinburgh and Nottingham found.

Funded by the British Heart Foundation and in partnership with the UK Dementia Research Institute, the study involved 363 people who had experienced a lacunar stroke.

Experts found the two drugs were even more effective when used in combination, and they could be available as a treatment for lacunar strokes within five years if results are confirmed in further trials.

As well as their standard stroke prevention treatment, participants took either isosorbide mononitrate or cilostazol individually, both drugs together, or neither for one year.

Participants who took both drugs were nearly 20% less likely to have problems with their thinking and memory compared to the group that did not take any of the trial drugs.

They also reported a better quality of life and were more independent.

Those who took mononitrate were also less likely to have had further strokes at one year than those who did not take the drug.

At least 35,000 people in the UK are affected by lacunar strokes every year and they are caused by cerebral small vessel disease, where small blood vessels deep within the brain become damaged and stop working properly.

Small vessel disease is also a common cause of cognitive impairment and dementia.

Those who suffer from strokes may develop problems with their thinking, memory and movement, and may go on to develop dementia.

Currently, there are no specific effective treatments.

The trial is set to become a larger four-year clinical trial which the researchers hope to start by the end of the year.

Professor Joanna Wardlaw, chair of applied neuroimaging at the University of Edinburgh and foundation chair at the UK Dementia Research Institute, said: “Now we understand more about what is triggering these small vessel strokes to attack the brain, we’ve been able to focus our efforts on treatments that can put a halt to this damage.

“We need to confirm these results in larger trials before either drug can be recommended as a treatment.

“However, as these drugs are already widely available for other circulatory disorders, and inexpensive, it shouldn’t take too long to move our findings from research into everyday clinical practice.”

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “These promising findings provide a long-awaited positive step towards the first treatments becoming available for lacunar strokes, offering much needed hope for thousands of people.

“Lacunar strokes are not the only way that cerebral small vessel disease can affect someone. These findings also open new avenues of research into other conditions related to small vessel disease, such as vascular dementia.”

Dr Richard Oakley, associate director of research at the Alzheimer’s Society, said: “We know that having a stroke is a major risk for developing vascular dementia, which is why we funded the study that led to this trial.

“It’s really positive that people who had experienced a deep brain stroke reduced their chance of having memory and thinking problems by nearly 20% when taking these two drugs.

“What’s more, the drugs are cheap – about 70p for one dose of both – and already licensed. Larger trials are needed to confirm their effectiveness, but if the results are positive, this treatment could be made available relatively quickly.

“We can only continue to fund this kind of cutting-edge research, and improve the lives of people living with dementia, with people’s help. Support our Forget Me Not Appeal this month to raise vital funds for everyone affected by dementia.”

The findings are published in the journal JAMA Neurology.