Long‐Term Secondary Preventive Medication Persistence and Adherence in Young Ischemic Stroke Survivors: A Prospective Single‐Center Cohort Study

INTRODUCTION: The study aimed to evaluate long-term medication persistence and adherence to secondary prevention therapies in young ischemic stroke survivors (aged 18-49 years) and identify factors influencing these outcomes. METHODS: The single-center prospective cohort study enrolled young ischemic stroke patients (aged 18-49 years) from March 2017 to March 2023. Medication persistence (continuation of all prescribed secondary prevention drugs) and adherence (assessed by the Morisky Medication Adherence Scale-8 (MMAS-8)) were evaluated, with reasons for discontinuation and influencing factors analyzed. RESULTS: Among 226 patients (median age 35 years, 34.5% female), 80.1% remained persistent with their medication regimen over a median follow-up of 3.9 years. Patients with persistence had higher rates of large artery atherosclerosis (42% vs. 22.2%, p = 0.015) and comorbid diabetes (13.3% vs. 2.2%, p = 0.015). The median MMAS-8 score was 7 (6-7.38), with 24.2% showing high adherence, 63% moderate adherence, and 12.8% poor adherence. Poor adherence was associated with younger age (