# Medication adherence to secondary prevention after ischemic cerebrovascular disease: a real-world outcomes analysis

## TL;DR

This study examines medication adherence after ischemic cerebrovascular disease and finds that better adherence is linked to lower risks of death and stroke recurrence.

## Contribution

The study provides real-world evidence on medication adherence patterns and their impact on outcomes in ischemic cerebrovascular disease patients.

## Key findings

- High adherence to lipid-lowering drugs was associated with a 14% reduced risk of all-cause death.
- Female patients were 37% less likely to adhere to lipid-lowering drugs compared to male patients.
- Only 50% of patients showed high adherence to antiplatelet medications.

## Abstract

Ischemic cerebrovascular disease (ICD) poses a major global burden. Non-adherence to medical secondary prevention leads to recurrent events and disability. Real-world data on adherence to preventive medications is scarce. The objective here is to determine adherence to secondary prevention of ICD and its effect on clinical outcomes.

This retrospective observational study was based on claims data from a large Swiss health insurance. We studied patients aged 18 years or older, who were hospitalized for ICD between 2017 and 2021. Patients’ one-year medication adherence was determined by the medication possession ratio (MPR, high adherence defined as MRP ≥ 0.80). Outcome variables were all-cause death, recurrent stroke, admission to nursing home, and major adverse cardiovascular events.

A total of 9,911 patients with ischemic stroke or TIA were included in the analysis. Lipid-lowering drugs (LLD) had the largest proportion of high adherence users (63.2%), followed by antihypertensives (55.4%) and antiplatelets (50.0%). Female patients were 37% less likely to adhere to LLD therapy than men, highlighting a significant gender gap. Users with high adherence to LLD had a significantly reduced risk for all-cause death (HR 0.86, 95% CI 0.79, 0.94); Direct oral anticoagulants (HR 0.88, 95% CI 0.78, 1.00) and antihypertensives (HR 0.93, 95% CI 0.85, 1.01) showed a trend towards a protective effect.

A remarkable proportion of patients were non-users or had low adherence to medical secondary prevention. Since insufficient secondary prevention may lead to an increased all-cause death rate, efforts are needed to raise awareness among healthcare professionals and improve patient compliance.