{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T06:41:16Z","timestamp":1772779276323,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ischemic cerebrovascular disease (ICD) poses a major global burden. Non-adherence to medical secondary prevention leads to recurrent events and disability. Real-world data on adherence to preventive medications is scarce. The objective here is to determine adherence to secondary prevention of ICD and its effect on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study was based on claims data from a large Swiss health insurance. We studied patients aged 18\u202fyears or older, who were hospitalized for ICD between 2017 and 2021. Patients\u2019 one-year medication adherence was determined by the medication possession ratio (MPR, high adherence defined as MRP\u202f\u2265\u202f0.80). Outcome variables were all-cause death, recurrent stroke, admission to nursing home, and major adverse cardiovascular events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 9,911 patients with ischemic stroke or TIA were included in the analysis. Lipid-lowering drugs (LLD) had the largest proportion of high adherence users (63.2%), followed by antihypertensives (55.4%) and antiplatelets (50.0%). Female patients were 37% less likely to adhere to LLD therapy than men, highlighting a significant gender gap. Users with high adherence to LLD had a significantly reduced risk for all-cause death (HR 0.86, 95% CI 0.79, 0.94); Direct oral anticoagulants (HR 0.88, 95% CI 0.78, 1.00) and antihypertensives (HR 0.93, 95% CI 0.85, 1.01) showed a trend towards a protective effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A remarkable proportion of patients were non-users or had low adherence to medical secondary prevention. Since insufficient secondary prevention may lead to an increased all-cause death rate, efforts are needed to raise awareness among healthcare professionals and improve patient compliance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1764948","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T05:30:13Z","timestamp":1772775013000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Medication adherence to secondary prevention after ischemic cerebrovascular disease: a real-world outcomes analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Sabrina M.","family":"Stollberg","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Helsana Group","place":["Zurich, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andri","family":"Signorell","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Helsana Group","place":["Zurich, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas R.","family":"Luft","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Zurich, University of Zurich","place":["Zurich, Switzerland"]},{"name":"Cereneo Center for Neurology and Rehabilitation, Vitznau","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola A.","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Helsana Group","place":["Zurich, Switzerland"]},{"name":"Institute of Primary Care, University Hospital Zurich, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1056\/NEJMoa1804492","article-title":"Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016","volume":"379","author":"Feigin","year":"2018","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s10072-020-04797-5","article-title":"Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis","volume":"42","author":"Lin","year":"2021","journal-title":"Neurol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.amjmed.2013.01.033","article-title":"Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis","volume":"126","author":"Kumbhani","year":"2013","journal-title":"Am J Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12916-019-1298-5","article-title":"Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis","volume":"17","author":"Tramacere","year":"2019","journal-title":"BMC Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S1474-4422(23)00277-6","article-title":"Pragmatic solutions to reduce the global burden of stroke: a world stroke organization-lancet neurology commission","volume":"22","author":"Feigin","year":"2023","journal-title":"Lancet Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1161\/STROKEAHA.119.027160","article-title":"Derivation and application of a tool to estimate benefits from multiple therapies that reduce recurrent stroke risk","volume":"51","author":"Richards","year":"2020","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1017\/cjn.2021.127","article-title":"Canadian stroke best practice recommendations: secondary prevention of stroke update 2020","volume":"49","author":"Gladstone","year":"2022","journal-title":"Can J Neurol Sci"},{"key":"ref9","volume-title":"Deutsche Schlaganfall-Gesellschaft und Deutsche Gesellschaft f\u00fcr. 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