Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Abstract

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.

Polymorphisms in genes related to inflammation and endothelial function are associated with ischemic stroke and other vascular events in populations at high risk of stroke Short title: A community-based survey and cohort study in southwestern China

“…This study revealed that a previous history of stroke was found to be independently correlated with an increased chance of experiencing new ischemic stroke and a combination of vascular events. This nding is consistent with prior research [16,19]. However, the study did not uncover any correlations between other conventional risk variables and the occurrence of new ischemic stroke or composite vascular events.…”

“…The detailed information about the high-risk stroke populations was described in Table 1 in our previous articles [19] and Fig. 1.…”

“…In the high-risk stroke populations, 2698 (93.3%) completed the 4.7-year follow-up after the face-to-face survey, and 195 (6.7%) lost to follow-up. In the 2698 high-risk stroke populations, 721(26.7%) subjects had diabetes mellitus, 1949 (72.2%) had hypertension, 751 (27.8%) had dyslipidemia, 487 (18.1%) had a history of stroke (88 hemorrhagic strokes, 399 ischemic strokes) at face-to-face survey [19]. ).…”

“…Thus, the results of our study may not represent the full spectrum of the Chinese population. Third, our previous study has demonstrated that the persistence of drug therapy is crucial to decreasing stroke and other vascular events [19]. The main aim of this study was to evaluate the association of the 19 SNPs and the interaction among these SNPs with outcomes.…”

Inflammation and endothelial function relevant genetic polymorphisms, carotid atherosclerosis, and vascular events in high-risk stroke population

“…Fourth, although we found that the high-risk interactive genotypes in ITGA2 rs1991013, IL1A rs1609682, and HABP2 rs7923349 independently increased ischemic stroke and other vascular events, the detailed molecular mechanisms remain unclear. Finally, our previous study has shown that the persistence of drug therapy (including statins, antiplatelet drugs, and antihypertensives) was associated with a lower risk for stroke and other vascular events (41). The major aim of the present study was to investigate the associations of the 19 SNPs and the interaction among these SNPs with outcomes.…”