Abstract
Aims: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. Methods: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. Results: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88–0.94), 7% (RR 0.93, 95% CI: 0.84–1.03), and 10% (RR 0.90, 95% CI: 0.88–0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81–0.87), 17% (RR 0.83, 95% CI: 0.78–0.89), and 13% (RR 0.87, 95% CI: 0.84–0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87–0.92), 12% (RR 0.88, 95% CI: 0.82–0.94), and 9% (RR 0.91, 95% CI: 0.89–0.94). Conclusions: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.
Highlights
Among the 35 studies reporting on cardiovascular events (CVEs) outcome, we found a 20% increment in a cardiovascular medication adherence level was associated with a 9% lower risk of CV
In 23 studies with available data on stroke, we found a 20% increment in any cardiovascular medication adherence level was associated with a 16% lower risk of stroke (RR: 0.84, 95% confidence intervals (CIs): 0.81–0.87, I2 = 96.1%, Pheterogeneity < 0.001, Figure S5)
Among the 26 studies reporting on all-cause mortality, we found a 20% increment in any cardiovascular medication adherence level was associated with an 10% lower risk of all-cause mortality (RR: 0.90, 95% CI: 0.87–0.92, I2 = 98.2%, Pheterogeneity < 0.001, Figure S9)
Summary
Cardiovascular disease (CVD) is a disease of the heart and circulatory system. It is the leading cause of death and chronic disability worldwide, accounting for one-third of global deaths [1,2]. It is estimated that 23.6 million people will die from CVD by 2030 [3]. Stroke is one of the most important causes of mortality worldwide [4].
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