Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke

M N Gynnild; R Aakerøy; O Spigset; T Askim; M K Beyer; H Ihle-Hansen; R Munthe-Kaas; A B Knapskog; S Lydersen; H Naess; T G Røsstad; Y M Seljeseth; P Thingstad; I Saltvedt; H Ellekjaer

doi:10.1111/joim.13161

Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke

J Intern Med. 2021 Mar;289(3):355-368. doi: 10.1111/joim.13161. Epub 2020 Aug 19.

Authors

M N Gynnild^{1

2}, R Aakerøy³, O Spigset^{3

4}, T Askim¹, M K Beyer^{5

6}, H Ihle-Hansen^{7

8}, R Munthe-Kaas^{5

7}, A B Knapskog⁸, S Lydersen⁹, H Naess^{10

11

12}, T G Røsstad¹³, Y M Seljeseth¹⁴, P Thingstad¹, I Saltvedt^{1

15}, H Ellekjaer^{1

2}

Affiliations

¹ From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
² Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
³ Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁴ Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁷ Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway.
⁸ Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
⁹ Department of Mental Health, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
¹⁰ Department of Neurology, Haukeland University Hospital, Bergen, Norway.
¹¹ Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
¹² Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
¹³ Department of Health and Welfare Services, City of Trondheim, Trondheim, Norway.
¹⁴ Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway.
¹⁵ Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

PMID: 32743852
DOI: 10.1111/joim.13161

Abstract

Background: 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.

Methods: 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^-1 ) and haemoglobin A1c (HbA1c) (≤53 mmol mol^-1 ) and determinants of risk factor control.

Results: 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).

Conclusion: 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.

Trial registration: ClinicalTrials.gov NCT02650531.

Keywords: blood pressure; cardiovascular disease; medication adherence; secondary prevention; stroke.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Female
Humans
Ischemic Stroke / prevention & control*
Male
Medication Adherence*
Norway
Polypharmacy
Risk Factors
Secondary Prevention*

Associated data

ClinicalTrials.gov/NCT02650531