缺血性脑卒中后3年的二级预防和血管风险控制。

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-06-05 DOI:10.1177/23969873251329210

Erlend Fagerli, Hanne Ellekjær, Olav Spigset, Ingvild Saltvedt, Mari Nordbø Gynnild

{"title":"缺血性脑卒中后3年的二级预防和血管风险控制。","authors":"Erlend Fagerli, Hanne Ellekjær, Olav Spigset, Ingvild Saltvedt, Mari Nordbø Gynnild","doi":"10.1177/23969873251329210","DOIUrl":null,"url":null,"abstract":"Introduction: 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.Patients and methods: 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.Results: 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.Conclusion: 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.","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251329210"},"PeriodicalIF":4.5000,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Three-year adherence to secondary prevention and vascular risk control after ischemic stroke.\",\"authors\":\"Erlend Fagerli, Hanne Ellekjær, Olav Spigset, Ingvild Saltvedt, Mari Nordbø Gynnild\",\"doi\":\"10.1177/23969873251329210\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: 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.Patients and methods: 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.Results: 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.Conclusion: 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.\",\"PeriodicalId\":46821,\"journal\":{\"name\":\"European Stroke Journal\",\"volume\":\" \",\"pages\":\"23969873251329210\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-06-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Stroke Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/23969873251329210\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Stroke Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23969873251329210","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

简介：缺血性卒中后二级预防的长期依从性尚不清楚。本研究旨在评估卒中后3年患者的药物依从性、血管治疗目标的实现以及影响目标实现的临床特征。患者和方法：我们纳入了2015年5月至2017年3月期间入院的挪威卒中后认知障碍研究中的665例居家缺血性卒中患者（n = 431例，随访3年）。用药依从性采用Morisky药物依从性量表、用药持久性和基于指南的治疗目标：血压（BP）进行评估。结果：出院时，抗血栓药物的处方率为97%，抗高血压药物为67%，降脂药物（LLD）为88%，降糖药为10%。三年后，坚持率分别为97%、91%、83%和94%，其中73%报告高药物依从性。糖尿病患者血压、LDL-C和HbA1c的目标完成率分别为42%、47%和75%。年龄越小，血压控制越好（OR 0.974 /年，95% CI 0.957-0.992）。女性LDL-C控制较差（OR 0.55, 95% CI 0.33-0.91）。更多的低密度脂蛋白（OR 1.25, 95% CI 1.14-1.37）和更高的合并症（OR 1.26, 95% CI 1.10-1.44）与LDL-C控制的改善相关。结论：缺血性卒中后3年的危险因素控制仍不理想，尽管相对较高的坚持和依从率。加强对挪威卒中患者实施最佳二级预防的关注是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

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

Introduction: 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.

Patients and methods: 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.

Results: 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.

Conclusion: 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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.