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Longitudinal Adherence Trajectories to Statins and Antithrombotic Therapy After Ischemic Stroke and Their Impact on
Shih-Wei Wang1,2, Hung-Sheng Lin3,4, Che-Wei Hsu5
1School of Pharmacy Kaohsiung Medical University Kaohsiung Taiwan.
Insights
Maintaining adherence to secondary prevention medications like statins and antithrombotics after stroke is crucial. Consistent dual adherence significantly reduces cardiovascular risks and mortality, while early discontinuation increases these risks.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Secondary prevention adherence after ischemic stroke/transient ischemic attack is often suboptimal.
- Clinical impact of adherence patterns to statins and antithrombotics remains unclear.
Purpose of the Study:
- Identify adherence trajectories for statins and antithrombotic agents.
- Evaluate associations between adherence patterns, lipid control, and cardiovascular outcomes.
Main Methods:
- Utilized Taiwan's population claims data (2012-2018) for patients with first-ever ischemic stroke/TIA.
- Group-based multitrajectory modeling classified monthly adherence (proportion of days covered).
- Primary outcome: composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction; secondary: individual components and all-cause death.
Main Results:
- Identified 4 adherence trajectories: dual high (46.7%), antithrombotic-only (35.1%), early dual discontinuation (12.2%), gradual dual decline (6.0%).
- Dual high adherence showed greatest LDL-C reduction (-24.3%) and lowest mortality.
- Early dual discontinuation significantly increased risks for composite outcomes, recurrent events, MI, and all-cause death (aHRs ranging from 1.48 to 1.60).
Conclusions:
- Adherence trajectories strongly correlate with low-density lipoprotein cholesterol levels and major cardiovascular events.
- Sustained dual adherence provides significant protection against recurrent events and mortality.
- Early discontinuation of secondary prevention therapies markedly elevates risks.
Background:
Adherence to secondary prevention therapies after ischemic stroke or transient ischemic attack is often suboptimal, and the clinical implications of adherence patterns remain unclear. This study identified adherence trajectories to statins and antithrombotic agents and evaluated their associations with lipid control and cardiovascular outcomes.
Methods:
Using the Chang Gung Research Database linked to Taiwan's population claims data, we identified patients with first-ever acute ischemic stroke/transient ischemic attack between 2012 and 2018 who survived ≥1 year and initiated secondary prevention. Monthly adherence was measured by proportion of days covered and classified using group-based multitrajectory modeling. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction; secondary outcomes included individual components and all-cause death.
Results:
Among 13 299 eligible patients (mean age, 65.6 years; 60.3% men), 4 adherence trajectories were identified: dual high adherence (46.7%), antithrombotic-only adherence (35.1%), early dual discontinuation (12.2%), and gradual dual decline (6.0%). Dual high adherence achieved the greatest low-density lipoprotein cholesterol reduction (-24.3%) and lowest mortality rate. Early dual discontinuation was associated with higher risks of the composite outcome (adjusted hazard ratio [aHR], 1.57 [95% CI, 1.31-1.88], recurrent ischemic stroke/systemic embolism (aHR, 1.60 [95% CI, 1.31-1.95]), myocardial infarction (aHR, 1.48 [95% CI, 1.02-2.14]), and all-cause death (aHR, 1.56 [95% CI, 1.36-1.79]). Poor adherence had greater adverse impact among patients with baseline low-density lipoprotein cholesterol ≥100 mg/dL, younger adults, and men.
Conclusions:
Adherence trajectories were strongly associated with low-density lipoprotein cholesterol and major cardiovascular outcomes. Sustained dual adherence conferred substantial protection, whereas early discontinuation markedly increased recurrent ischemic and mortality risks.
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