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

摘要：

目的 研究健康教育对他汀类药物服用持续性的影响，以及他汀类药物服用持续性对大动脉粥样 硬化性缺血性卒中患者复发的影响。 

方法 本研究患者源于2013年7月-2015年6月的前瞻性队列研究——缺血性脑血管病患者二级预 防、康复技术的综合疾病管理模式的推广研究。该研究采用随机数字表法将入组医院以4∶1分为健 康教育组（北京24所医院）和对照组（北京6所医院）。健康教育组采用在住院期间为患者举办健康 教育会并发放健康教育手册、在出院后为患者发送健康教育短信的干预措施；对照组则无上述干预 措施。连续纳入该队列研究中出院时服用他汀类药物的大动脉粥样硬化性缺血性卒中患者。随访患 者发病1年内是否持续服用他汀类药物及缺血性卒中复发的情况；分析健康教育对他汀类药物服用持 续性的影响，以及他汀类药物服用持续性对缺血性卒中复发的影响。 

结果 最终纳入2000例患者，年龄27～91岁，平均61.0±11.0岁，男性1499例（75.0%）；给予健康 教育患者1454例，未给予健康教育患者546例。1336例（66.8%）患者在发病1年内持续服用他汀 类药物，113例（5.7%）患者1年内发生缺血性卒中复发。健康教育（OR 1.298，95%CI 1.052～1.601， P =0.015）、年龄≤60岁（OR 1.242，95%CI 1.020～1.511，P =0.031）、高中及以上文化程度（OR 1.254， 95%CI 1.005～1.565，P =0.045）、有城镇职工医保（OR 1.382，95%CI 1.130～1.689，P =0.002）、冠 心病（OR 1.520，95%CI 1.122～2.058，P =0.007）、出院时mRS≥2分（OR 1.257，95%CI 1.035～1.528， P =0.021）的患者服用他汀类药物的持续性较好。年龄>60岁（HR 1.813，95%CI 1.216～2.702， P =0.003）、糖尿病（HR 1.888，95%CI 1.300～2.741，P =0.001）、缺血性卒中病史（HR 2.228， 95%C I 1.535～3.233，P <0.001）是1年内缺血性卒中复发的危险因素，而住院期间给予抗血 小板药物（HR 0.169，95%CI 0.068～0.420，P <0.001）、1年内持续服用他汀类药物（HR 0.616， 95%CI 0.421～0.903，P =0.013）可显著降低1年内缺血性卒中复发的风险。 

结论 健康教育可显著提高缺血性卒中患者服用他汀类药物的持续性，并且持续服用他汀类药物 可降低大动脉粥样硬化性缺血性卒中患者1年内的复发风险。

关键词: 缺血性卒中; 他汀类药物; 复发; 危险因素; 健康教育