Yi Xingyang, Chen Hong, Yu Ming, Luo Hua, Zhou Ju, Wei Wei, Wang Yanfen, Chen Xiaorong
Department of Neurology, People's Hospital of Deyang City, Deyang, China.
Department of Neurology, Suining Central Hospital, Suining, China.
Front Neurol. 2022 Jul 25;13:925061. doi: 10.3389/fneur.2022.925061. eCollection 2022.
The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.
高危卒中人群与卒中或其他血管事件风险增加显著相关。尽管有已证实有效的一级和二级卒中预防药物，但需持续使用才能起效。然而，在中国，药物治疗的持续性及其与高危卒中人群预后的关系研究较少。因此，根据2015年中国国家卒中筛查调查（CNSSS）项目，我们在中国西南部的四川开展了这项基于人群的多中心横断面调查和前瞻性队列研究。年龄≥40岁的居民自愿参与了8个社区的面对面调查。具有八个与卒中相关危险因素中的至少三个或有卒中病史的受试者被定义为高危卒中人群。访谈者在面对面调查时记录个体的用药情况，并对所有高危卒中人群进行了4.7年的随访。评估了抗高血压药、降糖药、降脂药和抗血栓药对卒中的治疗持续性。主要结局是新发卒中。次要结局包括随访期间卒中、心肌梗死和死亡的新发复合血管事件。在16892名参与者中，2893名（17.1%）参与者为高危卒中人群，2698名（93.3%）参与者完成了随访。抗高血压药、降糖药、降脂药和抗血栓药的4.7年治疗持续性率分别为38.0%、39.9%、43.9%和59.8%。同时患有高血压、糖尿病、血脂异常和卒中的患者中，抗高血压药、降糖药、降脂药和抗血栓药的总治疗持续性率为47.6%（136/286）。在4.7年的随访期间，有118例（4.4%）新发缺血性卒中、24例（0.9%）出血性卒中、53例（2.0%）心肌梗死和33例（1.2%）死亡。在调整协变量后，抗高血压药、降糖药、降脂治疗、抗血栓药的4.7年持续性以及总持续性与较少的新发缺血性卒中和较少的新发复合血管事件独立相关。因此，开展更有效的公众教育以及努力理解和提高药物治疗的持续性对于改善人群健康、降低高危卒中人群的卒中和其他血管事件至关重要。
