{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:35Z","timestamp":1789715015771,"version":"4.0.1"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Using the Chang Gung Research Database linked to Taiwan's population claims data, we identified patients with first\u2010ever acute ischemic stroke\/transient ischemic attack between 2012 and 2018 who survived \u22651 year and initiated secondary prevention. Monthly adherence was measured by proportion of days covered and classified using group\u2010based multitrajectory modeling. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, and myocardial infarction; secondary outcomes included individual components and all\u2010cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 13\u2009299 eligible patients (mean age, 65.6\u2009years; 60.3% men), 4 adherence trajectories were identified: dual high adherence (46.7%), antithrombotic\u2010only adherence (35.1%), early dual discontinuation (12.2%), and gradual dual decline (6.0%). Dual high adherence achieved the greatest low\u2010density lipoprotein cholesterol reduction (\u221224.3%) 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\u20131.88], recurrent ischemic stroke\/systemic embolism (aHR, 1.60 [95% CI, 1.31\u20131.95]), myocardial infarction (aHR, 1.48 [95% CI, 1.02\u20132.14]), and all\u2010cause death (aHR, 1.56 [95% CI, 1.36\u20131.79]). Poor adherence had greater adverse impact among patients with baseline low\u2010density lipoprotein cholesterol \u2265100 mg\/dL, younger adults, and men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Adherence trajectories were strongly associated with low\u2010density lipoprotein cholesterol and major cardiovascular outcomes. Sustained dual adherence conferred substantial protection, whereas early discontinuation markedly increased recurrent ischemic and mortality risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048456","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:10:44Z","timestamp":1778058644000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Adherence Trajectories to Statins and Antithrombotic Therapy After Ischemic Stroke and Their Impact on Low\u2010Density Lipoprotein Control and Cardiovascular Outcomes"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3314-4871","authenticated-orcid":false,"given":"Shih\u2010Wei","family":"Wang","sequence":"first","affiliation":[{"name":"Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]},{"name":"Kaohsiung Chang Gung Memorial Hospital","place":["Kaohsiung, 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