• Kimmo Herttua, Pekka Martikainen, G David Batty, and Mika Kivimäki.
• Centre of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark; Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland. Electronic address: kherttua@health.sdu.dk.
• J. Am. Coll. Cardiol. 2016 Apr 5; 67 (13): 1507-1515.

BackgroundPoor adherence to medication regimens is common, potentially contributing to the occurrence of related disease.ObjectivesThe authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/or antihypertensive therapy.MethodsWe conducted a population-based study using electronic medical and prescription records from Finnish national registers in 1995 to 2007. Of the 58,266 hypercholesterolemia patients age 30+ years without pre-existing stroke or cardiovascular disease, 532 patients died of stroke (cases), and 57,734 remained free of incident stroke (controls) during the mean follow-up of 5.5 years. We captured year-by-year adherence to statin and antihypertensive therapy in both study groups and estimated the excess risk of stroke death associated with nonadherence.ResultsIn all hypercholesterolemia patients, the adjusted odds ratio for stroke death for nonadherent compared with adherent statin users was 1.35 (95% confidence interval [CI] 1.04 to 1.74) 4 years before and 2.04 (95% CI: 1.72 to 2.43) at the year of stroke death or the end of the follow-up. In hypercholesterolemia patients with hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 (95% CI: 5.22 to 10.59) for those nonadherent both to statin and antihypertensive therapy, 1.82 (95% CI: 1.43 to 2.33) for those non-adherent to statin but adherent to antihypertensive therapy, and 1.30 (95% CI: 0.53 to 3.20) for those adherent to statin, but nonadherent to antihypertensive, therapy.ConclusionsIndividuals 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.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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