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Three-year adherence to secondary prevention and vascular risk control after ischemic stroke

Erlend Fagerli1, Hanne Ellekjær2,3, Olav Spigset4,5

  • 1Department of Circulation and Medical Imaging, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

European Stroke Journal
|January 30, 2026
PubMed

Insights

Three years after ischemic stroke, medication adherence was high, but vascular risk factor control remained poor. Enhanced secondary prevention strategies are needed for Norwegian stroke survivors to improve long-term outcomes.

Area of Science:

  • Neurology
  • Cardiology
  • Public Health

Background:

  • Long-term adherence to secondary prevention strategies after ischemic stroke is crucial but not well understood.
  • Evaluating medication adherence and achievement of vascular treatment targets is essential for optimizing post-stroke care.
  • Understanding factors influencing target achievement can guide personalized secondary prevention plans.

Purpose of the Study:

  • To assess medication adherence and persistence 3 years after ischemic stroke.
  • To evaluate the attainment of guideline-based vascular treatment targets (blood pressure, LDL cholesterol, HbA1c).
  • To identify clinical characteristics associated with achieving these secondary prevention targets.

Main Methods:

  • A cohort of 431 home-dwelling ischemic stroke patients from the Norwegian Cognitive Impairment After Stroke study were followed for 3 years.
  • Medication adherence was measured using the Morisky Medication Adherence Scale and medication persistence.
  • Treatment targets included blood pressure <140/90 mmHg, LDL cholesterol <2.0 mmol/L, and HbA1c ≤53 mmol/mol.

Main Results:

  • High medication persistence rates were observed at 3 years (97% antithrombotics, 91% antihypertensives, 83% lipid-lowering drugs).
  • Despite high adherence (73%), target achievement was suboptimal: 42% for blood pressure, 47% for LDL cholesterol.
  • Younger age correlated with better blood pressure control; female sex with poorer LDL cholesterol control.

Conclusions:

  • Risk factor control remains unsatisfactory 3 years post-ischemic stroke, despite good medication adherence and persistence.
  • Specific patient characteristics influence the achievement of vascular treatment targets.
  • There is a need for improved implementation of secondary prevention strategies in Norwegian stroke patients.
Abstract

Keywords:
Secondary preventionblood pressureischemic strokemedication adherencestrokevascular risk factors

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