What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Patients prescribed vascular medications. Intervention: Cardiovascular medication adherence. Primary outcome: Cardiovascular events (CVEs) (RR 0.91, 95% CI 0.88-0.94).

What does this research mean for the field?

A 20% increment in cardiovascular medication adherence is associated with significantly reduced risks of cardiovascular events, stroke, and all-cause mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the dose-response relationship between vascular medication adherence and the risks of cardio-cerebrovascular events, stroke, and all-cause mortality.

November 2, 2021Journal of Cardiovascular Development and Disease24 citationsOpen Access

Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis

MLMengying Liu GZGuowei Zheng XCXiting Cao

Key Result

A 20% increment in cardiovascular medication adherence was associated with reduced risks of cardiovascular events (RR 0.91), stroke (RR 0.84), and all-cause mortality (RR 0.90).

Key Points

To evaluate the dose-response relationship between vascular medication adherence and the risks of cardio-cerebrovascular events, stroke, and all-cause mortality.
Systematically searched PubMed, Web of Science, EMBASE, and Cochrane databases from inception through June 21, 2021, identifying 46 eligible articles.
Calculated pooled relative risks (RRs) and 95% confidence intervals (CIs) using random-effects meta-analysis and modeled dose-response curves using restricted cubic splines.
A 20% increment in adherence reduced cardiovascular events for overall cardiovascular (RR 0.91, 95% CI 0.88–0.94), antihypertensive (RR 0.93, 95% CI 0.84–1.03), and lipid-lowering therapies (RR 0.90, 95% CI 0.88–0.92).
Each 20% increase in adherence lowered stroke risk for cardiovascular (RR 0.84, 95% CI 0.81–0.87), antihypertensive (RR 0.83, 95% CI 0.78–0.89), and lipid-lowering drugs (RR 0.87, 95% CI 0.84–0.91).
All-cause mortality risk declined by 10% for cardiovascular (RR 0.90, 95% CI 0.87–0.92), 12% for antihypertensive (RR 0.88, 95% CI 0.82–0.94), and 9% for lipid-lowering regimens (RR 0.91, 95% CI 0.89–0.94) per 20% adherence gain.

Study Design

Type

Meta-Analysis

Structured PICO

Does better cardiovascular medication adherence reduce the risk of cardio-cerebrovascular events and all-cause mortality?

Population

Patients taking cardiovascular medications (46 articles included in the meta-analysis)

Intervention

Higher cardiovascular medication adherence (assessed by 20% increments in adherence level for cardiovascular, antihypertensive, and lipid-lowering medications)

Comparator

Lower medication adherence

Outcome

Cardiovascular events (CVEs), stroke, and all-cause mortalityhard clinical

A 20% increase in adherence to cardiovascular medications significantly reduces the risk of cardiovascular events, stroke, and all-cause mortality.

Main Result

Effect estimate: RR 0.91 (95% CI 0.88-0.94)

Abstract

AIMS: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. METHODS: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. RESULTS: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88-0.94), 7% (RR 0.93, 95% CI: 0.84-1.03), and 10% (RR 0.90, 95% CI: 0.88-0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81-0.87), 17% (RR 0.83, 95% CI: 0.78-0.89), and 13% (RR 0.87, 95% CI: 0.84-0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87-0.92), 12% (RR 0.88, 95% CI: 0.82-0.94), and 9% (RR 0.91, 95% CI: 0.89-0.94). CONCLUSIONS: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.

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