Clinical factors associated with statins prescription in acute ischemic stroke patients: findings from the Lombardia Stroke Registry

Abstract

BackgroundStatins, due to their well-established pleiotropic effects, have noteworthy benefits in stroke prevention. Despite this, a significant proportion of high-risk patients still do not receive the recommended therapeutic regimens, and many others discontinue treatment after being started on them. The causes of non-adherence to current guidelines are multifactorial, and depend on both physicians and patients. The aim of this study is to identify the factors influencing statin prescription at Stroke Unit (SU) discharge.MethodsThis study included 12,750 patients enrolled on the web-based Lombardia Stroke Registry (LRS) from July 2009 to April 2012 and discharged alive, with a diagnosis of ischemic stroke or transient ischemic attack (TIA) and without contra-indication to statin therapy. By logistic regression analysis and classification trees, we evaluated the impact of demographic data, risk factors, tPA treatment, in-hospital procedures and complications on statin prescription rate at discharge.ResultsWe observed a slight increase in statins prescription during the study period (from 39.1 to 43.9%). Lower age, lower stroke severity and prestroke disability, the presence of atherothrombotic/lacunar risk factors, a diagnosis of non-cardioembolic stroke, tPA treatment, the absence of in-hospital complications, with the sole exception of hypertensive fits and hyperglycemia, were the patient-related predictors of adherence to guidelines by physicians. Overall, dyslipidemia appears as the leading factor, while TOAST classification does not reach statistical significance.ConclusionsIn our region, Lombardia, adherence to guidelines in statin prescription at Stroke Unit discharge is very different from international goals. The presence of dyslipidemia remains the main factor influencing statin prescription, while the presence of well-defined atherosclerotic etiopathogenesis of stroke does not enhance statin prescription. Some uncertainties about the risk/benefit of statin therapy in stroke etiology subtypes (cardioembolism, other or undetermined causes) may partially justify the underuse of statin in ischemic stroke. The differences that exist between current international guidelines may prevent a more widespread use of statin and should be clarified in a consensus.

Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

“…We have addressed it in another study [ 19 ]. The increasing use of statins corresponded to lower cholesterol levels in our study group, which is consistent with other European registries [ 15 , 16 ].…”

Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil

“…Nevertheless, particularly, simvastatin in the double dose and high-intensity statins showed the most significant ability to recover functional gain in our population, possibly suggesting that such drugs may be preferentially indicated in more severe stroke patients with more significant functional impairment. Our results reflect a worldwide trend that many patients with ischemic stroke may be under-treated 15,17 .…”

Secondary CV Prevention in South America in a Community Setting: The PURE Study

“…Some barriers to medication adherence in survivors of strokes could be identified as potential reasons, such as increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination [24]. Possibly, underuse at stroke unit discharge may be related to uncertainties about efficacy in stroke subtypes and differences among current guidelines [43]. The most important predictor of statin use in ischemic stroke is previous history of CHD [44], and the prescription at discharge is strongly associated with statin intake prior to the event [45].…”