Key result
Early dual discontinuation of statins and antithrombotics is linked to ~57% higher vascular risk after stroke.
Why the study?
Does adherence to statins and antithrombotic therapy reduce recurrent ischemic stroke, systemic embolism, and myocardial infarction in patients with first-ever acute ischemic stroke or transient ischemic attack?
Cohort (n=13,299)
Yes
Does adherence to statins and antithrombotic therapy reduce recurrent ischemic stroke, systemic embolism, and myocardial infarction in patients with first-ever acute ischemic stroke or transient ischemic attack?
Hazard Ratio: 1.57 (95% CI 1.31–1.88)
Early discontinuation of statins and antithrombotic therapy after ischemic stroke significantly increases the risk of recurrent ischemic events and mortality.
BACKGROUND: Adherence to secondary prevention therapies after ischemic stroke or transient ischemic attack is often suboptimal, and the clinical implications of adherence patterns remain unclear. This study identified adherence trajectories to statins and antithrombotic agents and evaluated their associations with lipid control and cardiovascular outcomes. METHODS: Using the Chang Gung Research Database linked to Taiwan's population claims data, we identified patients with first-ever acute ischemic stroke/transient ischemic attack between 2012 and 2018 who survived ≥1 year and initiated secondary prevention. Monthly adherence was measured by proportion of days covered and classified using group-based multitrajectory modeling. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction; secondary outcomes included individual components and all-cause death. RESULTS: Among 13 299 eligible patients (mean age, 65.6 years; 60.3% men), 4 adherence trajectories were identified: dual high adherence (46.7%), antithrombotic-only adherence (35.1%), early dual discontinuation (12.2%), and gradual dual decline (6.0%). Dual high adherence achieved the greatest low-density lipoprotein cholesterol reduction (-24.3%) and lowest mortality rate. Early dual discontinuation was associated with higher risks of the composite outcome (adjusted hazard ratio [aHR], 1.57 [95% CI, 1.31-1.88], recurrent ischemic stroke/systemic embolism (aHR, 1.60 [95% CI, 1.31-1.95]), myocardial infarction (aHR, 1.48 [95% CI, 1.02-2.14]), and all-cause death (aHR, 1.56 [95% CI, 1.36-1.79]). Poor adherence had greater adverse impact among patients with baseline low-density lipoprotein cholesterol ≥100 mg/dL, younger adults, and men. CONCLUSIONS: Adherence trajectories were strongly associated with low-density lipoprotein cholesterol and major cardiovascular outcomes. Sustained dual adherence conferred substantial protection, whereas early discontinuation markedly increased recurrent ischemic and mortality risks.
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Wang et al. (2026) conducted a cohort in first-ever acute ischemic stroke or transient ischemic attack (n=13,299). Early dual discontinuation of statins and antithrombotic therapy vs. Dual high adherence was evaluated on Composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction (aHR 1.57, 95% CI 1.31-1.88). Early dual discontinuation of statins and antithrombotic therapy after ischemic stroke was associated with higher risk of recurrent stroke, systemic embolism, and MI (aHR 1.57; 95% CI 1.31-1.88).