title: Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke.
abstract: Poor adherence to medication regimens is common, potentially contributing to the occurrence of related disease.
  
  
  
  The authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/or antihypertensive therapy.
  
  
  
  We conducted a population-based study using electronic medical and prescription records from Finnish national registers in 1995 to 2007. Of the 58,266 hypercholesterolemia patients age 30+ years without pre-existing stroke or cardiovascular disease, 532 patients died of stroke (cases), and 57,734 remained free of incident stroke (controls) during the mean follow-up of 5.5 years. We captured year-by-year adherence to statin and antihypertensive therapy in both study groups and estimated the excess risk of stroke death associated with nonadherence.
  
  
  
  In all hypercholesterolemia patients, the adjusted odds ratio for stroke death for nonadherent compared with adherent statin users was 1.35 (95% confidence interval [CI] 1.04 to 1.74) 4 years before and 2.04 (95% CI: 1.72 to 2.43) at the year of stroke death or the end of the follow-up. In hypercholesterolemia patients with hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 (95% CI: 5.22 to 10.59) for those nonadherent both to statin and antihypertensive therapy, 1.82 (95% CI: 1.43 to 2.33) for those non-adherent to statin but adherent to antihypertensive therapy, and 1.30 (95% CI: 0.53 to 3.20) for those adherent to statin, but nonadherent to antihypertensive, therapy.
  
  
  
  Individuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies.
authors.affiliation: Centre of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark; Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland. Electronic address: kherttua@health.sdu.dk.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Herttua
authors.affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; The Max Planck Institute for Demographic Research, Rostock, Germany.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: adherence; hypercholesterolemia; hypertension; mortality; statin and antihypertensive therapy; stroke