Abstract 11997: Statin Adherence is a Predictor of Clinical Outcomes in Patients with Acute Ischemic Stroke
Objectives: Statin therapy has demonstrated clinical benefits in atherosclerotic diseases. Recent evidences showed that statin adherence may influence clinical outcomes in patients with ischemic heart disease. We assessed the effect of statin adherence on clinical outcomes in patients with acute ischemic stroke (IS).
Methods and Results: We screened patients who were admitted due to their first IS or transient ischemic attack (TIA) and without prior statin therapy from January 2001 to December 2001 using the databank of the Bureau of National Health Insurance in Taiwan. Patients were enrolled into this study if they initiated statin therapy during hospitalization or within 3 months after discharge. Statin adherence of each subject was defined by medication possession ratio (MPR) which was calculated as total days covered by prescribed statin in the following one year after statin was initiated divided by 365 days. Eligible subjects were divided into 3 groups according to MPR: good adherence group (n=337, mead age 64.3 years, male 45%) were patients having MPR > 80%; intermediate adherence group (n=379, mean age 64.3 years, male 48%) were patients having MPR between 40% to 80%, and poor adherence group (n=775, mean age 66 years, male 44.7%) were patients having MPR < 40%. The study end point was the composite outcome of recurrent IS, hemorrhagic stroke, TIA and acute coronary event one year later after statin was initiated. All eligible patients were followed up until December 31, 2004 and Cox proportional hazards model was used to evaluate the effect of MPR of statin on clinical outcome. At the end of follow-up, patients in poor adherence group had worse clinical outcome than those in good adherence group (event rate: 19% vs 13.9%, p<0.01). Poor statin adherence was an independent predictor of worse clinical outcome after adjusting for other confounding clinical factors (hazard ratio: 1.51; 95% adjusted CI: 1.09-2.19) when compared with good adherence group. Patients in intermediate adherence group also had a trend to have higher event rate than patients with good adherence (hazard ratio: 1.25; 95% CI: 0.86 to 1.83).
Conclusions: Our study showed that good statin adherence was related to better clinical outcomes in patients with acute IS or TIA.
- © 2011 by American Heart Association, Inc.