Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke

Mar 28, 2016
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Authors:
Herttua K, Martikainen P, Batty GD, Kivimäki M.
Citation:
Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke. J Am Coll Cardiol 2016;67:1507-1515.
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

What is the risk of fatal stroke associated with nonadherence to statin and/or antihypertensive therapy in hypercholesterolemic men and women?

Methods:

A population-based study was conducted using electronic medical and prescription records from Finnish national registers in 1995-2007. The authors assessed the year-by-year adherence to statin and antihypertensive therapy in those who died of stroke and those who were free of incident stroke.

Results:

There was a total of 58,266 patients with hypercholesterolemia aged >30 years without pre-existing stroke or cardiovascular disease. Five hundred and thirty-two patients died of stroke (cases), and 57,734 remained free of incident stroke (controls). In all hypercholesterolemia patients, the adjusted odds ratio for stroke death (odds ratio; 95% confidence interval) for nonadherent compared to adherent statin users was 1.35 (1.04-1.74) 4 years prior to, and 2.04 (1.72-2.43) at the year of stroke death or the end of the follow-up. In those who also had hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 for those nonadherent both to statin and antihypertensive therapy, 1.82 for those nonadherent to statin but adherent to antihypertensive therapy, and 1.30 for those adherent to statin but nonadherent to antihypertensive therapy.

Conclusions:

Individuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies.

Perspective:

Unlike in primary and secondary coronary disease prevention, stroke rates appear to decline in proportion to reduction in cholesterol and blood pressure. The results of the outcome study are intuitive, but the magnitude of benefit of remaining compliant to just antihypertensive drugs or statins is impressive. Regardless, it further supports a ‘polypill’ for stroke and cardiovascular event reduction.

Keywords: Antihypertensive Agents, Blood Pressure, Cholesterol, Coronary Disease, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Hypertension, Outcome Assessment, Health Care, Primary Prevention, Risk Factors, Secondary Prevention, Stroke


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