Objective To investigate the factors associated with statins persistence and the effect of statins
persistence on stroke recurrence in patients with large artery atherosclerotic ischemic stroke.
Methods This study was based on the data from a prospective cohort study, the promotion study
of the comprehensive disease management pattern of secondary prevention and rehabilitation
technology for patients with ischemic cerebrovascular disease. The enrolled hospitals were
randomly divided into health education group (24 hospitals in Beijing) and control group (6 hospitals in Beijing) by random number table. The following interventions were took in health education group, such as holding health education training and distributing health education
manuals for patients during hospitalization, and sending health education messages for patients after
discharge. The control group had no above interventions. The patients with large atherosclerotic
ischemic stroke who took statins at discharge were consecutively enrolled into this current study.
Stroke risk factors, the use of statins medication, and any recurrent ischemic stroke within one year
were recorded. The factors affecting statins persistence and the effect of statins persistence on stroke
recurrence were analyzed.
Results A total of 2000 patients were enrolled, with a mean age of 61.0±11.0 years (range: 27-91
years) and 1499 males (75.0%), 1454 patients in health education group and 546 patients in control
group. A total of 1336 (66.8%) patients took statins persistently during the first year. Ischemic
stroke occurred in 113 patients (5.7%) within one year after stroke onset. Comprehensive health
education interventions (OR 1.298, 95%CI 1.052-1.601, P =0.015) significantly improved statins
persistence within the first year. The age ≤60 years (OR 1.242, 95%CI 1.020-1.511, P =0.031), high
education degree (OR 1.254, 95%CI 1.005-1.565, P =0.045), urban medical insurance (OR 1.382,
95%CI 1.130-1.689, P =0.002), coronary heart disease (OR 1.520, 95%CI 1.122-2.058, P =0.007),
and mRS ≥2 at discharge (OR 1.257, 95%CI 1.035-1.528, P =0.021) were associated with a better
statins persistence. Age >60 years (HR 1.813, 95%CI 1.216-2.702, P =0.003), diabetes mellitus (HR
1.888, 95%CI 1.300-2.741, P =0.001), and history of ischemic stroke (HR 2.228, 95%CI 1.535-
3.233, P <0.001) were independent predictors of 1-year recurrent stroke. Antiplatelet therapy during
hospitalization (HR 0.169, 95%CI 0.068-0.420, P <0.001) and taking statins persistently within
one year (HR 0.616, 95%CI 0.421-0.903, P =0.013) significantly reduced 1-year ischemic stroke
recurrence.
Conclusions The health education can significantly improve statins persistence, and statins
persistence significantly reduced 1-year recurrent stroke in patients with large artery atherosclerotic
ischemic stroke.
