# Three-year adherence to secondary prevention and vascular risk control after ischemic stroke

## TL;DR

This study finds that three years after an ischemic stroke, many patients still struggle to control vascular risk factors despite generally adhering to prescribed medications.

## Contribution

The study provides novel insights into long-term medication adherence and vascular risk control in ischemic stroke patients over a three-year period.

## Key findings

- Three years post-stroke, persistence rates for antithrombotics, antihypertensives, and lipid-lowering drugs remained high.
- Only 42% of patients achieved blood pressure targets, and 47% achieved LDL cholesterol targets.
- Women and older patients had poorer control of LDL cholesterol and blood pressure, respectively.

## Abstract

Long-term adherence to secondary prevention after ischemic stroke remains unclear. This study aimed to evaluate medication adherence, attainment of vascular treatment targets, and clinical characteristics that influence target achievement 3 years post-stroke.

We included 665 home-dwelling ischemic stroke patients from the Norwegian Cognitive Impairment After Stroke study, admitted between May 2015 and March 2017 (n = 431 were followed for 3 years). Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale, medication persistence, and guideline-based treatment targets: blood pressure (BP) < 140/90 mmHg, LDL cholesterol (LDL-C) < 2.0 mmol/L, and hemoglobin A1c (HbA1c) ⩽ 53 mmol/mol.

At discharge, prescription rates were 97% for antithrombotics, 67% for antihypertensives, 88% for lipid-lowering drugs (LLD), and 10% for antidiabetics. Three years later, persistence rates were 97%, 91%, 83%, and 94%, respectively, with 73% reporting high medication adherence. Target achievement rates were 42% for BP, 47% for LDL-C, and 75% for HbA1c among diabetic patients. Younger age was associated with better BP control (OR 0.974 per year, 95% CI 0.957–0.992). Women had poorer LDL-C control (OR 0.55, 95% CI 0.33–0.91). More LLD (OR 1.25, 95% CI 1.14–1.37) and higher comorbidity (OR 1.26, 95% CI 1.10–1.44) were associated with improved LDL-C control.

Control of risk factors remained unsatisfactory 3 years after ischemic stroke, despite relatively high persistence and adherence rates. Improved focus on implementing optimal secondary prevention for Norwegian stroke patients is necessary.

Graphical abstract