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In an accompanying editorial comment, Sidney C. Smith Jr., MD, writes
that this study “underlines the tragic
consequences of non-adherence to
statin and antihypertensive therapy.”
Smith also stressed the need to “stepup efforts in health care systems globally to increase adherence to preventative medical therapies,” through use of
strategies like “fixed-dose combination
pills, teleprompting, increased counseling, and ongoing involvement by
health care professionals such as specialized nurses, and a new awareness
about the impact of media directed
educational messages on patient behavior.” Smith adds: “Without stronger efforts to improve adherence by
patients to prescribed medications and
behavior change, our evidence-based
treatments will continue to fall short
of their potential, sometimes tragically
resulting in fatal stroke.”
Fatal Stroke: Tragic Consequences
of Nonadherence
Some patients who are non-adherent to statin and antihypertensive
prescriptions may have a more than
seven-fold greater risk of stroke than
those who take these medications, according to a study recently published
March 28 in JACC.
Kimmo Herutta, PhD, and
colleagues examined 58,266 hypercholesterolemia patients. Of these
patients, 58% of men and 60% of
women were adherent to statins. Over
the 5.5 follow-up years, a total 532 of
patients died of stroke and the other
57,734 patients remained free of
incident stroke. Those who died were
older and less educated and were
more likely to have diabetes or cancer.
Breaking it down by age, 52% of
those aged < 57 year, 60% of those
aged 57–65 years, 63% of those
aged 66–72 years and 61% of those
aged ≥ 72 years were adherent.
There was an observed elevated risk
of stroke death among those who
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were non-adherent to statins, which
increased in magnitude in the year
prior to the stroke death. The largest
risk of stroke death was observed in
those with poor adherence. During
the year of the event, the odds of
stroke death were 2.23 times higher
in this group compared to those
with high adherence.
Patients who were non-adherent
to statin and antihypertensive therapy
had greater than seven-fold increased
odds of fatal stroke at the year of
stroke death compared to those who
were adherent. Patients who were
non-adherent to statin but adherent to
antihypertensive therapy had a 1.8-fold
increased risk and those who were nonadherent to antihypertensive therapy
but adherent to statins had a 1.3-fold
increased risk compared to those who
were adherent to both treatments.
Non-adherence to statin therapy was associated with a two-fold increased risk
of fatal stroke in the last year of life.
Herttua K, Martikainen P, Batty GD, Kivimäki M. J Am Coll Cardiol. 2016;doi:10.1016/j.
jacc.2016.01.044.
Encouraging
News on Renal
Disease and RAAS
Inhibitors
Treatment with either an angiotensinconverting enzyme (ACE) inhibitor
or an angiotensin receptor blocker
(ARB) was associated with improved
long-term survival following acute
myocardial infarction, according to
research published April 4 in JACC.
These findings suggest that all MI
patients should be prescribed one
of these medications for secondary
prevention.
Researchers analyzed 64,442 MI
patients from the SWEDEHEART
registry. At discharge 70.9% of
patients used either an ACE inhibitor (58.4%) or an ARB (13.6%). By
3 months post-discharge, 16.7% of
patients who have not been taking an
“[This study]
underlines
the tragic
consqeuences of
non-adherence
to statin and
antihypertensive
therapy.”
—Sidney C. Smith, Jr., MD
ACE inhibitor or ARB began to do so.
Of those treated at discharge, 2.1%
discontinued use after 3 months and
30% had discontinued use by 3 years
after discharge. During the 3 year
follow-up 12.6% of ACE inhibitor users switched to ARB and 5.8% of ARB
users switched to an ACE inhibitor.
A total of 12,745 (19.8%) patients
died during follow-up: 4,772 (25.4%)
patients in the non-Ace inhibitor/ARB
group and 7,973 (17.4%) patients
in the ACE inhibitor/ARB treatment
group. Mortality rates increased as renal function worsened. Mortality was
lower in ACE inhibitor/ARB treated
patients than non-treated patients.
The survival benefit of ACE inhibitors/ARB was seen across all levels of
renal function, including patients on
dialysis.
A total of 10,030 (15.6%) patients
were admitted with a new fatal or
nonfatal MI and 3,697 (5.7%) with
April 2016