ABSTRACT

Background:

Prior stroke is one of the biggest risk factors for future stroke events. Effective secondary prevention medication regimens can dramatically reduce recurrent stroke risk. Guidelines recommend the use of antithrombotic, antihypertensive and lipid-lowering medications after stroke. Medication adherence is known to be better in the presence of a caregiver but long-term adherence after stroke is unknown and disparities may persist.

Methods:

We examined the effects of race and sex on baseline prescription and maintenance of secondary prevention regimens in the presence of a caregiver using the Caring for Adults Recovering from the Effects of Stroke (CARES) study, an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS).

Results:

Incident ischemic stroke survivors (N = 172; 36% Black) with family caregivers had medications recorded at hospital discharge and on average 9.8 months later during a home visit. At discharge, antithrombotic prescription (95.9%), lipid-lowering medications (78.8%) and antihypertensives (89.9%) were common and there were no race or sex differences in discharge prescription rates. One year later, medication persistence had fallen to 86.6% for antithrombotics (p = 0.002) and 69.8% for lipid lowering (p = 0.008) but increased to 93.0% for antihypertensives (p = 0.30). Blacks were more likely to have discontinued antithrombotics than Whites (18.3% v 7.7%, p = 0.04). No significant differences in persistence were seen with age, sex, income, depression, or cognitive impairment.

Conclusions:

Medication persistence was high in this sample, likely due to the presence of a caregiver. In our cohort, despite similar prescription rates at the time of hospital discharge, Black stroke survivors were more than twice as likely to stop antithrombotics than Whites. The effect of changes in patterns of medication usage on health outcomes in Black stroke survivors warrants continued investigation.

中文翻译：

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缺血性卒中后二级预防药物治疗方案的种族差异

摘要

背景：

既往卒中是未来卒中事件的最大风险因素之一。有效的二级预防药物治疗方案可以显着降低复发性卒中风险。指南建议卒中后使用抗血栓、抗高血压和降脂药物。已知在有护理人员的情况下药物依从性更好，但中风后的长期依从性尚不清楚，并且差异可能会持续存在。

方法：

我们使用照顾从中风影响中恢复的成年人 (CARES) 研究来检查种族和性别对基线处方和二级预防方案维持的影响，该研究是国家地理和种族原因的辅助研究中风的差异（问候）。

结果：

有家庭护理人员的缺血性卒中幸存者（N  = 172；36% 黑人）在出院时和平均 9.8 个月后的家访期间记录了药物。出院时，抗血栓药（95.9%）、降脂药（78.8%）和抗高血压药（89.9%）很常见，出院处方率没有种族或性别差异。一年后，抗血栓药的持续用药率下降至 86.6% ( p  = 0.002) 和降脂药的 69.8% ( p  = 0.008)，但抗高血压药的持续用药率上升至 93.0% ( p  = 0.30)。黑人比白人更有可能停用抗血栓药物（18.3% 对 7.7%，p = 0.04)。年龄、性别、收入、抑郁或认知障碍的持久性没有显着差异。

结论：

该样本中的药物持久性很高，可能是由于护理人员的存在。在我们的队列中，尽管出院时的处方率相似，但黑人中风幸存者停止使用抗血栓药物的可能性是白人的两倍多。药物使用模式变化对黑人中风幸存者健康结果的影响值得继续调查。