Journal of the American Heart Association · 2026
Longitudinal Adherence Trajectories to Statins and Antithrombotic Therapy After Ischemic Stroke and Their Impact on Low-Density Lipoprotein Control and Cardiovascular Outcomes.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wang Shih-Wei, Lin Hung-Sheng, Hsu Che-Wei, Chen Chung-Yu, Saito Hiroshi, Chen Fu-Shih
Аннотация
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.
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.