Medication adherence and its influence on the prognosis of individuals at high risk of stroke: a prospective multi-center study_West China Medical Journal

Authors：

LI Jie ¹ , ZHANG Ping ¹ , HUANG Kaisen ² , CHEN Hong ¹ , QING Ting ¹ , WANG Chun ¹ ,  YI Xingyang ¹

1. Department of Neurology, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;
2. Department of Cardiovascular Medicine, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

YI Xingyang, Email: YiXingYang64@126.com

Keywords：

Stroke; high-risk individual; medication adherence; prognosis

DOI：

10.7507/1002-0179.202202037

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Objective To investigate the medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents and its influence on the prognosis of individuals at high risk of stroke. Methods A total of 16892 residents aged 40 years or above in eight communities in Sichuan participated in a face-to-face study from May to September 2015. A database of a high-risk population of stroke in Sichuan province was established, and data were collected via using a standardized structured questionnaire by experienced investigators, including the treatment status and medication compliance of participants with hypertension, diabetes, or dyslipidemia during the follow-up period. Multiple logistic regression analyses were performed to explore the influencing factors of medication adherence and its influence on the prognosis of individuals at high risk of stroke. Results A total of 2893 participants at high risk of stroke were enrolled. The treatment rates of hypertension, diabetes, and dyslipidemia were 50.1%, 49.2%, and 5.1%, respectively, when the high-risk individuals were identified. At the end of follow-up (with a median follow-up period of 4.8 years), the treatment rates of hypertension, diabetes, and dyslipidemia were 24.8%, 25.0%, and 7.9%, respectively. Medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents were 27.8%, 25.5%, and 18.1%, respectively. Multiple logistic regression analyses showed that the education level of high school or above [odds ratio (OR)=2.134, 95% confidence interval (CI) (1.098, 4.147), P=0.025], medical insurance for urban residents [OR=1.556, 95%CI (1.086, 2.230), P=0.016] and urban employees [OR=2.325, 95%CI (1.362, 3.967), P=0.002], having fewer children [OR=0.819, 95%CI (0.719, 0.933), P=0.003], and family history of stroke [OR=1.559, 95%CI (1.066, 2.282), P=0.022] were associated with greater adherence to antihypertensives; medical insurance for urban employees was associated with greater adherence to antidiabetics [OR=2.494, 95%CI (1.173, 5.300), P=0.018]. After adjusting for confounding factors, failure to regular use of antihypertensives [OR=2.617, 95%CI (1.414, 4.842), P=0.002], antidiabetics [OR=3.909, 95%CI (2.394, 6.380), P<0.001], and lipid-lowering agents [OR=4.828, 95%CI (2.581, 9.033), P<0.001] in patients with hypertension, diabetes, and dyslipidemia, respectively were associated with increased risk of ischemic stroke during the follow-up period. Regular use of lipid-lowering agents in patients with dyslipidemia was associated with an increased risk of intracerebral hemorrhage during the follow-up [OR=4.371, 95%CI (1.156, 16.530), P=0.030]. Conclusions The prevalences of hypertension, diabetes, and dyslipidemia are high in high-risk individuals of stroke in Sichuan province. However, the treatment rates are unsatisfactory, and the medication adherence is poor. The medication adherence is affected by a variety of demographic and socioeconomic factors. Regular treatments of hypertension, diabetes, and dyslipidemia reduce the risk of ischemic stroke in individuals at high risk of stroke, but regular use of lipid-lowering agents in patients with dyslipidemia is associated with an increased risk of intracerebral hemorrhage during the follow-up.

Citation： LI Jie, ZHANG Ping, HUANG Kaisen, CHEN Hong, QING Ting, WANG Chun, YI Xingyang. Medication adherence and its influence on the prognosis of individuals at high risk of stroke: a prospective multi-center study. West China Medical Journal, 2022, 37(6): 823-829. doi: 10.7507/1002-0179.202202037 Copy

1.	Wu SM, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2.	GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL, Nguyen G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med, 2018, 379(25): 2429-2437.
3.	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告 2019》概要. 中国脑血管病杂志, 2020, 17(5): 272-281.
4.	O’Neal WT, Kamel H, Zhang ZM, et al. Advanced interatrial block and ischemic stroke: the Atherosclerosis Risk in Communities Study. Neurology, 2016, 87(4): 352-356.
5.	Kuo F, Gardener H, Dong C, et al. Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque. Stroke, 2012, 43(7): 1755-1760.
6.	Marino F, Tozzi M, Schembri L, et al. Production of IL-8, VEGF and elastase by circulating and intraplaque neutrophils in patients with carotid atherosclerosis. PLoS One, 2015, 10(4): e0124565.
7.	Li J, Wang L, Chao B, et al. Prevalence of stroke in China: an epidemiological study based on the National Stroke Screening Survey. Lancet, 2015, 386(Special Issue 1): S49.
8.	Yi X, Luo H, Zhou J, et al. Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China. BMC Neurol, 2020, 20(1): 5.
9.	Canner PL, Forman SA, Prud’Homme GJ. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. N Engl J Med, 1980, 303(18): 1038-1041.
10.	Bian L, Xia L, Wang Y, et al. Risk factors of subclinical atherosclerosis and plaque burden in high risk individuals: results from a community-based study. Front Physiol, 2018, 9: 739.
11.	马丽珍, 李学军, 陈路, 等. 脑卒中高危人群的风险评估研究. 中国全科医学, 2015(10): 1150-1152, 1156.
12.	Mi T, Sun S, Du Y, et al. Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China. Brain Behav, 2016, 6(5): e00461.
13.	吕翔, 陶定波, 曹华, 等. 缺血性脑卒中危险人群一级预防的现状调查及随访. 中国实用神经疾病杂志, 2015, 18(22): 44-46.
14.	Farzadfar F, Finucane MM, Danaei GA, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet, 2011, 377(9765): 578-586.
15.	钟文菲. 高血压患者服药依从性影响因素调查. 现代预防医学, 2011, 38(18): 3826-3827, 3829.
16.	郦清懿. 老年糖尿病患者服药依从性的研究进展. 上海护理, 2013, 13(6): 73-76.
17.	王文志. 应重视脑卒中首次发病风险评估. 中华健康管理学杂志, 2018, 12(5): 385-388.
18.	Iso H, Jacobs DJ, Wentworth D, et al. Serum cholesterol levels and six-year mortality from stroke in 350, 977 men screened for the multiple risk factor intervention trial. N Engl J Med, 1989, 320(14): 904-910.
19.	丁亚楠, 王冀伟, 杜磊, 等. 脑出血发病与血脂水平异常的关系研究. 中国医药导报, 2013, 10(22): 164-165, 168.
20.	Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med, 2006, 355(6): 549-559.
21.	Collins R, Armitage J, Parish S, et al. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet, 2004, 363(9411): 757-767.
22.	阮晓霞. 血脂异常与脏器出血关系的研究进展. 心血管病学进展, 2015, 36(2): 176-179.

1. Wu SM, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2. GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL, Nguyen G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med, 2018, 379(25): 2429-2437.
3. 《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告 2019》概要. 中国脑血管病杂志, 2020, 17(5): 272-281.
4. O’Neal WT, Kamel H, Zhang ZM, et al. Advanced interatrial block and ischemic stroke: the Atherosclerosis Risk in Communities Study. Neurology, 2016, 87(4): 352-356.
5. Kuo F, Gardener H, Dong C, et al. Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque. Stroke, 2012, 43(7): 1755-1760.
6. Marino F, Tozzi M, Schembri L, et al. Production of IL-8, VEGF and elastase by circulating and intraplaque neutrophils in patients with carotid atherosclerosis. PLoS One, 2015, 10(4): e0124565.
7. Li J, Wang L, Chao B, et al. Prevalence of stroke in China: an epidemiological study based on the National Stroke Screening Survey. Lancet, 2015, 386(Special Issue 1): S49.
8. Yi X, Luo H, Zhou J, et al. Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China. BMC Neurol, 2020, 20(1): 5.
9. Canner PL, Forman SA, Prud’Homme GJ. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. N Engl J Med, 1980, 303(18): 1038-1041.
10. Bian L, Xia L, Wang Y, et al. Risk factors of subclinical atherosclerosis and plaque burden in high risk individuals: results from a community-based study. Front Physiol, 2018, 9: 739.
11. 马丽珍, 李学军, 陈路, 等. 脑卒中高危人群的风险评估研究. 中国全科医学, 2015(10): 1150-1152, 1156.
12. Mi T, Sun S, Du Y, et al. Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China. Brain Behav, 2016, 6(5): e00461.
13. 吕翔, 陶定波, 曹华, 等. 缺血性脑卒中危险人群一级预防的现状调查及随访. 中国实用神经疾病杂志, 2015, 18(22): 44-46.
14. Farzadfar F, Finucane MM, Danaei GA, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet, 2011, 377(9765): 578-586.
15. 钟文菲. 高血压患者服药依从性影响因素调查. 现代预防医学, 2011, 38(18): 3826-3827, 3829.
16. 郦清懿. 老年糖尿病患者服药依从性的研究进展. 上海护理, 2013, 13(6): 73-76.
17. 王文志. 应重视脑卒中首次发病风险评估. 中华健康管理学杂志, 2018, 12(5): 385-388.
18. Iso H, Jacobs DJ, Wentworth D, et al. Serum cholesterol levels and six-year mortality from stroke in 350, 977 men screened for the multiple risk factor intervention trial. N Engl J Med, 1989, 320(14): 904-910.
19. 丁亚楠, 王冀伟, 杜磊, 等. 脑出血发病与血脂水平异常的关系研究. 中国医药导报, 2013, 10(22): 164-165, 168.
20. Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med, 2006, 355(6): 549-559.
21. Collins R, Armitage J, Parish S, et al. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet, 2004, 363(9411): 757-767.
22. 阮晓霞. 血脂异常与脏器出血关系的研究进展. 心血管病学进展, 2015, 36(2): 176-179.

West China Medical Journal

Medication adherence and its influence on the prognosis of individuals at high risk of stroke: a prospective multi-center study

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