Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis

Liu, Mengying; Zheng, Guowei; Cao, Xiting; Chang, Xiaohong; Liang, Ge; Wang, Anran; Yu, Yan; Yang, Yongli; Zhao, Yang; Shi, Xiaoguang; Hu, Dongsheng; Lu, Jie

doi:10.3390/jcdd8110146

Cited by 15 publications

(14 citation statements)

References 38 publications

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“…The increasing risks of stroke-related events and all-cause mortality in our study were similar to the previous meta-analyses on assessments of medication adherence to statins [ 21 ], antihypertensives [ 22 ], and/or cardiovascular medications [ 15 , 16 ]. Although these studies focused on the risks of stroke-associated outcomes linked to medication adherence, they did not consider the impacts of other disease risk factors.…”

Section: Discussionsupporting

confidence: 88%

“…Some studies demonstrated that medication adherence is essential in stroke management to reach optimal clinical outcomes [ 14 ]. Previous meta-analyses reported that higher adherence to cardiovascular medications was associated with a decreased risk of coronary heart disease, stroke, and all-cause mortality [ 15 , 16 ]. Although medication adherence benefits patients at risk of stroke, around forty to fifty percent of patients do not take their cardiovascular medications as prescribed [ 15 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…The findings indicated that medication non-adherence was not associated with bleeding risk and stroke events [ 20 ]. Other studies targeted medication adherence to individual cardiovascular-related medications (i.e., antihyperlipidemic and antihypertensive medications) and relevant outcomes (e.g., stroke events and all-cause mortality) but did not consider or adjust for the other major disease risk factors (e.g., diabetes mellitus [DM]) [ 15 , 16 , 21 , 22 ]. Their findings reported that medication adherence was associated with decreased risk of stroke events and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

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Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis

Huang

Lin

2023

J Neurol

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Background 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. Objectives 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. Methods 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). Results 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. Conclusions 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.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis

Huang

Lin

2023

J Neurol

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“…Conversely, optimal adherence was associated with significantly reducing cardiovascular events and mortality. A recent meta-analysis indicated that each incremental 20% increase in adherence level of cardiovascular medication reduced the risk of cardiovascular events by 9%, stroke by 16%, and all-cause mortality by 10% [39]. Several clinical studies highlighted the benefits of cardiovascular medications and the importance of adherence to prescribed medications to optimize health outcomes.…”

Section: Medication Adherence-related Outcomes 41 Clinical Outcomesmentioning

confidence: 99%

Medication Adherence in Cardiovascular Diseases

Pham¹,

Nguyen²,

Tran³

et al. 2023

Novel Pathogenesis and Treatments for Cardiovascular Disease

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Cardiovascular disease is a significant cause of death globally. While effective long-term medications that reduce the risk of morbidity and mortality related to cardiovascular disease are readily available, nonadherence to prescribed medications remains a significant reason for suboptimal management. Consequently, this might lead to increased morbidity and mortality and healthcare costs. Medication nonadherence causes are myriad and complicated, with factors at the patient, healthcare provider, and health system levels. Many clinical trials have investigated interventions to target these factors for improving medication adherence, including improving patient education, testing behavioral interventions, implementing medication reminder tools, reducing medication costs, utilizing social support, utilizing healthcare team members, and simplifying medication dosing regimens. This book chapter describes factors influencing medication adherence and highlights the impact of varying levels of adherence on patients’ clinical and economic outcomes. We also summarize interventions for improving medication adherence in cardiovascular disease.

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“…Good adherence reduces the risk of fatal or non-fatal coronary heart disease, stroke or sudden cardiac death [ 25 ]. Liu et al performed a meta-analysis of 46 articles to assess for a dose response between CV medication adherence, CV events and all-cause mortality [ 26 ]. Data were available for 4,051,338 unique patients, average age 60.1 years, 44% female.…”

mentioning

confidence: 99%