{"id":"b6dd1ec85a03","type":"article","url":"https://hartvaat.nl/2026/05/19/therapietrouw-trajecten-na-ischemisch-cva-vroeg-dubbel-staken-verhoogt-sterfte-e/","title":"Therapietrouw-trajecten na ischemisch CVA: vroeg dubbel staken verhoogt sterfte en recidief met ~50%","title_en":"","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.048456","source_url":"https://doi.org/10.1161/JAHA.125.048456","authors":["Shih-Wei Wang","Hung-Sheng Lin","Che-Wei Hsu","Chung-Yu Chen","Hiroshi Saito","Fu-Shih Chen"],"significance":7,"published":"2026-06-12","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"Cohort study using Taiwanese registry data (Chang Gung Research Database linked to nationwide claims) of 13,299 patients with first-ever ischaemic stroke or TIA between 2012 and 2018 who survived ≥1 year and initiated secondary prevention. Monthly adherence (proportion of days covered) was modelled into four trajectories: high dual adherence (46.7%), antithrombotic-only (35.1%), early dual discontinuation (12.2%), and gradual dual decline (6.0%). High dual adherence achieved the greatest LDL reduction (-24.3%) and lowest mortality. Early dual discontinuation was associated with higher composite outcome (aHR 1.57), recurrent stroke/embolism (aHR 1.60), myocardial infarction (aHR 1.48), and all-cause death (aHR 1.56). Poor adherence had greater impact in patients with baseline LDL ≥100 mg/dL, younger adults, and men. Sustained dual adherence confers substantial protection; early discontinuation markedly elevates recurrence and mortality risk.","created":"2026-07-03T10:33:02Z","updated":"2026-07-03T13:31:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cohortstudie op Taiwanese registerdata (Chang Gung Research Database, gekoppeld aan landelijke claims) van 13.299 patiënten met een eerste ischemisch CVA of TIA tussen 2012 en 2018 die ≥1 jaar overleefden en secundaire preventie startten. Maandelijkse therapietrouw werd via proportion-of-days-covered gemodelleerd in vier trajecten: hoge dubbele trouw (46,7%), alleen-antitromboticum (35,1%), vroeg dubbel staken (12,2%) en geleidelijke dubbele afname (6,0%). Hoge dubbele trouw gaf de grootste LDL-reductie (-24,3%) en de laagste mortaliteit. Vroeg dubbel staken was geassocieerd met meer samengestelde events (aHR 1,57), recidief CVA/embolie (aHR 1,60), myocardinfarct (aHR 1,48) en totale sterfte (aHR 1,56). Slechte therapietrouw was nadeliger bij baseline LDL ≥100 mg/dL, jongere volwassenen en mannen. Volgehouden duale therapietrouw biedt aanzienlijke bescherming; vroege staking geeft fors verhoogd recidief- en sterfterisico.","abstract_original":"BACKGROUND: Adherence to secondary prevention therapies after ischemic stroke or transient ischemic attack is often suboptimal, and the clinical implications of adherence patterns remain unclear. This study identified adherence trajectories to statins and antithrombotic agents and evaluated their associations with lipid control and cardiovascular outcomes. METHODS: Using the Chang Gung Research Database linked to Taiwan's population claims data, we identified patients with first-ever acute ischemic stroke/transient ischemic attack between 2012 and 2018 who survived ≥1 year and initiated secondary prevention. Monthly adherence was measured by proportion of days covered and classified using group-based multitrajectory modeling. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction; secondary outcomes included individual components and all-cause death. RESULTS: Among 13 299 eligible patients (mean age, 65.6 years; 60.3% men), 4 adherence trajectories were identified: dual high adherence (46.7%), antithrombotic-only adherence (35.1%), early dual discontinuation (12.2%), and gradual dual decline (6.0%). Dual high adherence achieved the greatest low-density lipoprotein cholesterol reduction (-24.3%) and lowest mortality rate. Early dual discontinuation was associated with higher risks of the composite outcome (adjusted hazard ratio [aHR], 1.57 [95% CI, 1.31-1.88], recurrent ischemic stroke/systemic embolism (aHR, 1.60 [95% CI, 1.31-1.95]), myocardial infarction (aHR, 1.48 [95% CI, 1.02-2.14]), and all-cause death (aHR, 1.56 [95% CI, 1.36-1.79]). Poor adherence had greater adverse impact among patients with baseline low-density lipoprotein cholesterol ≥100 mg/dL, younger adults, and men. CONCLUSIONS: Adherence trajectories were strongly associated with low-density lipoprotein cholesterol and major cardiovascular outcomes. Sustained dual adherence conferred substantial protection, whereas early discontinuation markedly increased recurrent ischemic and mortality risks."}