TitlePoor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke.
Publication TypeJournal Article
Year of Publication2016
AuthorsHerttua, K, Martikainen, P, Batty, GD, Kivimäki, M
JournalJ Am Coll Cardiol
Volume67
Issue13
Pagination1507-1515
Date Published04/2016
ISSN1558-3597
KeywordsAged, Antihypertensive Agents, Case-Control Studies, Female, Finland, Follow-Up Studies, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Hypertension, Male, Medication Adherence, Middle Aged, Registries, Risk Factors, Stroke
Abstract
 

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.

DOI10.1016/j.jacc.2016.01.044
Alternate JournalJ. Am. Coll. Cardiol.
PubMed ID27150680
PubMed Central IDPMC4863178
Grant ListMR/K013351/1 / / Medical Research Council / United Kingdom
MR/K026992/1 / / Medical Research Council / United Kingdom
R01 AG034454 / AG / NIA NIH HHS / United States
RG/13/2/30098 / / British Heart Foundation / United Kingdom