Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis

• Published in: Journal of neurology 2023-05, Vol.270 (5), p.2504-2516
• Main Authors: Mafruhah, Okti Ratna, Huang, Yen-Ming, Lin, Hsiang-Wen
• Format: Article
• Language: English
• Subjects: Case-Control Studies; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Disease prevention; Humans; Hyperlipidemia; Hypertension - complications; Hypertension - drug therapy; Hypertension - epidemiology; Medication Adherence; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Neurology; Neuroradiology; Neurosciences; Patient compliance; Review; Sensitivity analysis; Stroke; Stroke - drug therapy; Stroke - epidemiology; Stroke - prevention & control
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-023-11601-9

Background Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention. Objectives To investigate the effects of non-adherence to medications used to treat the modifiable risk of diseases on stroke-associated outcomes in primary stroke prevention. Methods Study records were searched from PubMed, Embase, and CINAHL. Those studies reported risks relevant to stroke-associated outcomes and medication non-adherence for patients diagnosed with four modifiable stroke-related diseases (atrial fibrillation [AF], hyperlipidemia, hypertension, and type 2 diabetes mellitus) but without stroke history were included for meta-analysis and further subgroup, sensitivity, and publication bias analyses. A random effect model was performed to analyse the pooled risk estimates of relative risk (RR) and 95% confidence intervals (CIs). Results Thirty-nine studies (with 2,117,789 participants in total) designed as cohort or case–control studies were included. Those patients presenting with four stroke-related diseases and categorised as medication non-adherent tended to result in stroke and/or associated death (all pooled RR ≥ 1 and 95% CI did not include 1). The findings of stratification and sensitivity analysis for each stroke-related disease showed a similar trend. Non-adherent patients with AF were prone to stroke occurrence (RR 1.852; 95% CI 1.583–2.166) but inclined to reduced bleeding (RR 0.894; 95% CI 0.803–0.996). The existence of publication bias warrants further interpretation. Conclusions Non-adherence to medications for the four stroke-related diseases contributes to the development of stroke and/or mortality in primary stroke prevention. More efforts are needed to improve patients’ medication adherence.