关键词: 缺血性卒中; 他汀类药物; 复发; 危险因素; 健康教育

Abstract:

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.

Key words: Ischemic stroke; Statin; Recurrence; Risk factor; Health education