ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Medication adherence to secondary prevention after ischemic cere-brovascular disease: a real-world outcomes analysis
Sabrina Maria Stollberg (Born Ebinger) 1
Andri Signorell 1
Andreas R Luft 2
Carola Huber 1
1. Helsana Insurance Group, Zurich, Switzerland
2. UniversitatsSpital Zurich Neurologische Klinik, Zürich, Switzerland
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Abstract
Background: 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. Methods: This retrospective observational study was based on claims data from a large Swiss health insurance. We studied patients aged 18 years or older, who were hospitalized for ICD between 2017 and 2021. Patients' one-year medication adherence was determined by the medication possession ratio (MPR, high adherence defined as MRP ≥ 0.80). Outcome variables were all-cause death, recurrent stroke, admission to nursing home, and major adverse cardiovascular events. Results: 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 us-ers (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. Conclusion: 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.
Summary
Keywords
Cardiovascular outcome, Ischemic cerebrovascular disease, Medication possession ratio, Secondary Prevention, Stroke recurrence
Received
10 December 2025
Accepted
06 February 2026
Copyright
© 2026 Stollberg (Born Ebinger), Signorell, Luft and Huber. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sabrina Maria Stollberg (Born Ebinger)
Disclaimer
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