Author + information
- Received October 14, 2015
- Revision received January 20, 2016
- Accepted January 24, 2016
- Published online April 5, 2016.
- Kimmo Herttua, PhDa,b,∗ ( )(, )
- Pekka Martikainen, PhDb,c,d,
- G. David Batty, DSce and
- Mika Kivimäki, PhDe,f
- aCentre of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
- bPopulation Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
- cCentre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- dThe Max Planck Institute for Demographic Research, Rostock, Germany
- eDepartment of Epidemiology and Public Health, University College London, London, United Kingdom
- fClinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- ↵∗Reprint requests and correspondence:
Dr. Kimmo Herttua, Centre of Maritime Health and Society, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark.
Background Poor adherence to medication regimens is common, potentially contributing to the occurrence of related disease.
Objectives The authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/or antihypertensive therapy.
Methods We 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.
Results In 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.
Conclusions Individuals 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.
Dr. Martikainen is supported by the Academy of Finland, NordForsk and Horizon 2020. Dr. Kivimäki is supported by the U.S. National Institutes of Health (R01AG034454), the Medical Research Council, United Kingdom (K013351), an Economic and Social Research Council professorial fellowship, and NordForsk, the Nordic Programme on Health and Welfare. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 14, 2015.
- Revision received January 20, 2016.
- Accepted January 24, 2016.
- 2016 American College of Cardiology Foundation