So, What’s New?

Abstract

See related article, pages 1557-1564. Does reduced medication access after a stroke increase the risk of recurrent stroke and subsequent disability? How many recurrent strokes in the population are attributable to poor control of risk factors, such as lack of treatment of elevated blood pressure (BP), high cholesterol, diabetes or the use of antiplatelet agents, etc? The article by Levine et al1 notes that ≈9% or an estimated 76 000 stroke survivors in the US were unable to afford their necessary medications. The characteristics of such individuals are, as would be expected from previous studies, lower income, lack of insurance, multiple diseases requiring high cost of treatments, lack of usual source of care and lack of disposable income to pay for the drugs. The critical question is if we could enhance adherence, would it have any effect on outcomes? The current report by Levine et al did not measure whether the lack of funds to pay for the drug therapy had any impact on the control of risk factors or whether it had any effect on the clinical outcomes of poststroke patients. However, other studies have clearly documented that adherence to drug therapies is an important component of reducing risk of disease. Most likely, levels of risk factors and adherence to therapies are the 2 critical variables that determine risk of both incident stroke and recurrent stroke.2–7 In 2001, Qureshi reported in 1252 survivors of myocardial infarction and stroke from the National Health And Nutrition Examination Survey (NHANES) III that only 53% of hypertensives were controlled. Blood glucose in diabetics was controlled in only about 50% and cholesterol was poorly controlled in 46%. About 18% of individuals were also still smoking cigarettes.8 In January 2002, Dr Claude Lenfant, then Director of the National Heart, Lung, …