Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:67

Article

Herttua, Kimmo^1,2  Martikainen, Pekka^2,3,4,5  Batty, G. David⁶  Kivimaeki, Mika^6,7 

[1] Univ Southern Denmark, Dept Publ Hlth, Ctr Maritime Hlth & Soc, Esbjerg, Denmark

[2] Univ Helsinki, Dept Social Res, Populat Res Unit, Helsinki, Finland

[3] Stockholm Univ, Ctr Hlth Equ Studies CHESS, S-10691 Stockholm, Sweden

[4] Karolinska Inst, Stockholm, Sweden

[5] Max Planck Inst Demograf Forsch, D-18057 Rostock, Germany

[6] UCL, Dept Epidemiol & Publ Hlth, London, England

[7] Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland

关键词: hypercholesterolemia;    hypertension;    mortality;    statin and antihypertensive therapy;    stroke;   

DOI  :  10.1016/j.jacc.2016.01.044

来源: Elsevier

【 摘 要 】

BACKGROUND Poor adherence to medication regimens is common, potentially contributing to the occurrence of related disease. OBJECTIVES The authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/ or antihypertensive therapy. METHODS We conducted a population-based study using electronic medical and prescription records from Finnish national registers in 1995 to 2007. Of the 58,266 hypercholesterolemia patients age 30+ years without pre-existing stroke or cardiovascular disease, 532 patients died of stroke (cases), and 57,734 remained free of incident stroke (controls) during the mean follow-up of 5.5 years. We captured year-by-year adherence to statin and antihypertensive therapy in both study groups and estimated the excess risk of stroke death associated with nonadherence. RESULTS In all hypercholesterolemia patients, the adjusted odds ratio for stroke death for nonadherent compared with adherent statin users was 1.35 (95% confidence interval [CI] 1.04 to 1.74) 4 years before and 2.04 (95% CI: 1.72 to 2.43) at the year of stroke death or the end of the follow-up. In hypercholesterolemia patients with hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 (95% CI: 5.22 to 10.59) for those nonadherent both to statin and antihypertensive therapy, 1.82 (95% CI: 1.43 to 2.33) for those non-adherent to statin but adherent to antihypertensive therapy, and 1.30 (95% CI: 0.53 to 3.20) for those adherent to statin, but nonadherent to antihypertensive, therapy. CONCLUSIONS Individuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies. (C) 2016 by the American College of Cardiology Foundation.

【 授权许可】

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