From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
J Intern Med. 2021 Mar;289(3):355-368. doi: 10.1111/joim.13161. Epub 2020 Aug 19.
Studies regarding adequacy of secondary stroke prevention are limited. We report medication adherence, risk factor control and factors influencing vascular risk profile following ischaemic stroke.
A total of 664 home-dwelling participants in the Norwegian Cognitive Impairment After Stroke study, a multicenter observational study, were evaluated 3 and 18 months poststroke. We assessed medication adherence by self-reporting (4-item Morisky Medication Adherence Scale) and medication persistence (defined as continuation of medication(s) prescribed at discharge), achievement of guideline-defined targets of blood pressure (BP) (<140/90 mmHg), low-density lipoprotein cholesterol (LDL-C) (<2.0 mmol L ) and haemoglobin A1c (HbA1c) (≤53 mmol mol ) and determinants of risk factor control.
At discharge, 97% were prescribed antithrombotics, 88% lipid-lowering drugs, 68% antihypertensives and 12% antidiabetic drugs. Persistence of users declined to 99%, 88%, 93% and 95%, respectively, at 18 months. After 3 and 18 months, 80% and 73% reported high adherence. After 3 and 18 months, 40.7% and 47.0% gained BP control, 48.4% and 44.6% achieved LDL-C control, and 69.2% and 69.5% of diabetic patients achieved HbA1c control. Advanced age was associated with increased LDL-C control (OR 1.03, 95% CI 1.01 to 1.06) and reduced BP control (OR 0.98, 0.96 to 0.99). Women had poorer LDL-C control (OR 0.60, 0.37 to 0.98). Polypharmacy was associated with increased LDL-C control (OR 1.29, 1.18 to 1.41) and reduced HbA1c control (OR 0.76, 0.60 to 0.98).
Risk factor control is suboptimal despite high medication persistence and adherence. Improved understanding of this complex clinical setting is needed for optimization of secondary preventive strategies.
关于二级卒中预防充分性的研究有限。我们报告缺血性卒中后药物依从性、危险因素控制以及影响血管风险状况的因素。
挪威认知障碍后卒中研究是一项多中心观察性研究，共纳入 664 名居家参与者，在卒中后 3 个月和 18 个月进行评估。我们通过自我报告（4 项 Morisky 药物依从性量表）和药物持续使用（定义为出院时开具的药物持续使用）评估药物依从性，评估血压（BP）（<140/90mmHg）、低密度脂蛋白胆固醇（LDL-C）（<2.0mmol/L）和糖化血红蛋白（HbA1c）（≤53mmol/mol）的指南定义目标达标情况，以及危险因素控制的决定因素。
出院时，97%的患者被开具抗血栓药物，88%的患者被开具降脂药物，68%的患者被开具降压药物，12%的患者被开具降糖药物。18 个月时，使用者的药物持续使用率分别降至 99%、88%、93%和 95%。在 3 个月和 18 个月时，分别有 80%和 73%的患者报告药物高度依从。在 3 个月和 18 个月时，分别有 40.7%和 47.0%的患者血压得到控制，48.4%和 44.6%的患者 LDL-C 得到控制，69.2%和 69.5%的糖尿病患者 HbA1c 得到控制。高龄与 LDL-C 控制改善相关（OR 1.03，95%CI 1.01-1.06）和血压控制降低相关（OR 0.98，0.96-0.99）。女性 LDL-C 控制较差（OR 0.60，0.37-0.98）。多药治疗与 LDL-C 控制改善相关（OR 1.29，1.18-1.41）和 HbA1c 控制降低相关（OR 0.76，0.60-0.98）。
尽管药物持续使用和依从性高，但危险因素控制仍不理想。需要进一步了解这种复杂的临床情况，以优化二级预防策略。
