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Poor adherence to BP medication, statins greatly increases fatal stroke risk
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Patients with hypercholesterolemia and hypertension who do not take their prescribed medications are at excessive risk for fatal stroke, researchers found.
The researchers conducted a population-based study based on Finnish national medical and prescription records from 1995 to 2007. They studied 58,266 patients aged at least 30 years with hypercholesterolemia and no prior stroke or CVD.
They determined year-by-year adherence to statins and antihypertensive medications and estimated excess risk for fatal stroke associated with nonadherence to those medications. Median follow-up was 5.5 years.
Kimmo Herttua, PhD, and colleagues compared the 532 participants who died of stroke during the study period with the 57,734 who did not.
Among those with hypercholesterolemia, nonadherent statin users were more likely to experience fatal stroke than adherent ones (adjusted OR for 4 years before death or end of follow-up = 1.35; 95% CI, 1.04-1.74; adjusted OR for year of death or end of follow-up = 2.04; 95% CI, 1.72-2.43), Herttua, from the Centre of Maritime Health and Society, department of public health, University of Southern Denmark, Esbjerg, Denmark, and colleagues wrote.
However, among those who had hypercholesterolemia and hypertension, participants who did not adhere to their statin and BP medication regimens were at very high risk for fatal stroke compared with those who did adhere (OR at year of stroke death = 7.43; 95% CI, 5.22-10.59), according to the researchers.
Those with both conditions who adhered to their BP medication regimen but not their statin regimen (OR at year of stroke death = 1.82; 95% CI, 1.43-2.33) were also at elevated risk for fatal stroke, but those who adhered to their statin regimen but not their BP medication regimen did not have significantly elevated risk (OR at year of stroke death = 1.3; 95% CI, 0.53-3.2), they wrote.
Ischemic stroke was the most common kind of stroke observed.
In a related editorial, Sidney C. Smith Jr., MD, FACC, FAHA, FESC, professor of medicine, Heart and Vascular Center, University of North Carolina at Chapel Hill and past president of the American Heart Association and the World Heart Federation, wrote that the study “provides compelling observational evidence that we must increase and focus our efforts on understanding and addressing the various factors associated with nonadherence to evidence-based therapies.”
Sidney C. Smith Jr.
He wrote that improving adherence “will require multiple strategies that can include fixed-dose combination pills, teleprompting, increased counseling, ongoing involvement by health care professionals such as specialized nurses and a new awareness of the impact of media-directed educational messages on patient behavior.” – by Erik Swain
Disclosure: The researchers and Smith report no relevant financial disclosures.
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