School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung City, 406040, Taiwan.
Department of Pharmacy, Universitas Islam Indonesia, Daerah Istimewa Yogyakarta, 55584, Indonesia.
J Neurol. 2023 May;270(5):2504-2516. doi: 10.1007/s00415-023-11601-9. Epub 2023 Feb 27.
Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention.
To investigate the effects of non-adherence to medications used to treat the modifiable risk of diseases on stroke-associated outcomes in primary stroke prevention.
Study records were searched from PubMed, Embase, and CINAHL. Those studies reported risks relevant to stroke-associated outcomes and medication non-adherence for patients diagnosed with four modifiable stroke-related diseases (atrial fibrillation [AF], hyperlipidemia, hypertension, and type 2 diabetes mellitus) but without stroke history were included for meta-analysis and further subgroup, sensitivity, and publication bias analyses. A random effect model was performed to analyse the pooled risk estimates of relative risk (RR) and 95% confidence intervals (CIs).
Thirty-nine studies (with 2,117,789 participants in total) designed as cohort or case-control studies were included. Those patients presenting with four stroke-related diseases and categorised as medication non-adherent tended to result in stroke and/or associated death (all pooled RR ≥ 1 and 95% CI did not include 1). The findings of stratification and sensitivity analysis for each stroke-related disease showed a similar trend. Non-adherent patients with AF were prone to stroke occurrence (RR 1.852; 95% CI 1.583-2.166) but inclined to reduced bleeding (RR 0.894; 95% CI 0.803-0.996). The existence of publication bias warrants further interpretation.
Non-adherence to medications for the four stroke-related diseases contributes to the development of stroke and/or mortality in primary stroke prevention. More efforts are needed to improve patients' medication adherence.
药物依从性是初级卒中预防的关键尝试之一。现有证据缺乏全面的综述，探讨药物依从性与卒中预防相关结局的关系。
探讨治疗可改变疾病风险的药物不依从与初级卒中预防中与卒中相关结局的关系。
从 PubMed、Embase 和 CINAHL 中搜索研究记录。纳入报告与卒中相关结局和药物不依从相关风险的研究，这些研究纳入的患者诊断为四种可改变的卒中相关疾病（房颤[AF]、血脂异常、高血压和 2 型糖尿病），但无卒中史，进行荟萃分析和进一步的亚组、敏感性和发表偏倚分析。采用随机效应模型分析相对风险（RR）和 95%置信区间（CI）的汇总风险估计值。
共纳入 39 项队列或病例对照研究（共 2117789 例患者）。那些被归类为药物不依从的患有四种卒中相关疾病的患者更容易发生卒中及/或相关死亡（所有汇总 RR≥1，95%CI 不包括 1）。对每种卒中相关疾病的分层和敏感性分析的结果显示出相似的趋势。AF 患者药物不依从者更易发生卒中（RR 1.852；95%CI 1.583-2.166），但出血风险降低（RR 0.894；95%CI 0.803-0.996）。存在发表偏倚，需要进一步解释。
四种卒中相关疾病药物不依从与初级卒中预防中卒中的发生和/或死亡率增加有关。需要进一步努力提高患者的药物依从性。
