Key result
High adherence to secondary prevention medications was associated with a lower 12-month composite rate of recurrent stroke, MACE, or death compared to low adherence (15.93% vs. 32.98%, P=0.001).
Why the study?
The study aimed to determine predictors of suboptimal medication adherence in patients with ischemic stroke and to examine the relationship between adherence and long-term cognitive, motor, and clinical outcomes.
Does high adherence to secondary prevention medications reduce the composite of recurrent ischemic stroke, MACE, and all-cause mortality and improve cognitive and motor recovery in patients with chronic ischemic stroke or TIA?
Cohort (n=276)
No
Does high adherence to secondary prevention medications reduce the composite of recurrent ischemic stroke, MACE, and all-cause mortality and improve cognitive and motor recovery in patients with chronic ischemic stroke or TIA?
In ischemic stroke survivors, poor adherence to secondary prevention pharmacotherapy is predicted by older age, lower education, self-pay status, higher stroke severity, and polypharmacy, and is significantly associated with worse metabolic control, inferior cognitive and motor recovery, and double the rate of 12-month cardiovascular and cerebrovascular events.
Answers are grounded in this paper and cite their sources.
High adherence was associated with fewer post-stroke events; hypothesis-generating and requires randomized confirmation before practice change.
Objectives: To determine predictors of suboptimal medication adherence in patients with ischemic stroke and to examine the relationship between adherence and long-term cognitive, motor and clinical outcomes.Methods: This retrospective cohort study included 276 patients with ischemic stroke.Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8).Patients scoring 6 or higher were categorized as having high adherence (n = 182), while those scoring below 6 were classified as having low adherence (n = 94).Laboratory assessments, including low-density lipoprotein cholesterol (LDL-C), glycated hemoglobin (HbA1c), and homocysteine, were performed at baseline and at 12 months.Cognitive and motor functions were evaluated at baseline and at 3, 6, and 12 months.The primary clinical endpoints at 12 months comprised recurrent ischemic stroke, major adverse cardiovascular events (MACE), and all-cause mortality.Results: Independent predictors of low adherence included older age (OR = 1.035), lower education (OR = 0.906), self-pay insurance (OR = 1.743), higher baseline NIHSS (OR = 1.336), and more discharge medications (OR = 1.295) (all P < 0.05).At 12 months, the high adherence group had significantly lower LDL-C, HbA1c, and homocysteine (all P < 0.05) than the low adherence group.They also exhibited superior cognitive and motor scores, and significantly better functional independence (all P < 0.001).The composite outcome rate was significantly lower in the high adherence group (15.93% vs. 32.98%,P = 0.001).Conclusion: Multiple patient-level factors predict poor adherence.Poor adherence is associated with worse metabolic control, higher rates of recurrent vascular events and mortality, and inferior long-term cognitive and functional recovery.
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Yang et al. (2026) conducted a cohort in Ischemic stroke or transient ischemic attack (n=276). High adherence to secondary prevention medications (MMAS-8 score >= 6) vs. Low adherence to secondary prevention medications (MMAS-8 score < 6) was evaluated on Composite of recurrent ischemic stroke, major adverse cardiovascular events (MACE), and all-cause mortality at 12 months (p=0.001). High adherence to secondary prevention medications was associated with a lower 12-month composite rate of recurrent stroke, MACE, or death compared to low adherence (15.93% vs. 32.98%, P=0.001).
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