Effect of Statin Therapy on Outcomes of Patients With Acute Ischemic Stroke and Atrial Fibrillation

Abstract

Background There is insufficient evidence on the effect of statins, particularly high‐intensity statins, in patients with acute ischemic stroke and atrial fibrillation. We investigated the impact of statins on the outcomes in these patients, including those who might be vulnerable to statin therapy and those without clinical atherosclerotic cardiovascular diseases. Methods and Results A total of 2153 patients with acute ischemic stroke and atrial fibrillation were enrolled in the present nationwide, multicenter, cohort study. The primary composite end point was the occurrence of net adverse clinical and cerebral events ( NACCE ; death from any cause, stroke, acute coronary syndrome, or major bleeding) over a 3‐year period based on statin intensity. NACCE rates were lower in patients receiving low‐ to moderate‐intensity (adjusted hazard ratio 0.64; 95% CI : 0.52‐0.78) and high‐intensity statins (hazard ratio 0.51; 95% CI 0.40‐0.66) than in those not receiving statin therapy. High‐intensity statins were associated with a lower risk for NACCE than low‐ to moderate‐intensity statins (hazard ratio 0.76; 95% CI 0.59‐0.96). Subgroup analyses showed that the differences in hazard ratio for 3‐year NACCE favored statin use across all subgroups, including older patients, those with low cholesterol levels, patients receiving anticoagulants, and patients without clinical atherosclerotic cardiovascular diseases. Magnified benefits of high‐intensity statins compared with low‐ to moderate‐intensity statins were observed in patients who underwent revascularization therapy and those under 75 years of age. Conclusions Statins, particularly high‐intensity statins, could reduce the risk for NACCE in patients with acute ischemic stroke and atrial fibrillation; this needs to be further explored in randomized controlled trials.

A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke

“…In China, stroke is one of the leading contributors to mortality and long-term morbidity at the national level [1,2]. Numerous clinical and animal studies have confirmed the efficacy of antiplatelets and statins in patients with acute ischaemic stroke (AIS) [3][4][5][6][7]. However, early neurological deterioration (END) may occur to a fraction of patients with AIS, even though they take antiplatelet agents and statins regularly [8][9][10].…”

Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis

“…Twenty-four articles were excluded for (1) not comparing statin users and non-users; (2) not reporting adjusted effect estimates; (3) not providing data about the outcomes of interest; and (4) having overlapping study populations. Finally, eight studies (five studies for post-stroke statin; three studies for pre-stroke statin) were included in this meta-analysis ( Figure 1 ) ( 6 , 12 – 14 , 18 – 21 ). We excluded the study of Lin et al ( 22 ) because of the population overlap with the study of Wu et al ( 13 ) and the lack of information on the initiation time of statin treatment after AF-related stroke.…”

“…All of these publications were observational studies, and they included 12,216 subjects. Six studies were performed using a single-center or multicenter hospital-based registry on acute ischemic stroke ( 6 , 12 , 14 , 19 – 21 ). The other two studies were population-based ( 13 , 18 ).…”

“…We conducted subgroup analyses to assess the effects of post-stroke statin therapy on clinical outcomes stratified by statin intensity and patient subgroup type (hospital-based vs. population-based). Two studies analyzed the intensity-related effects of statin therapy on mortality and recurrent ischemic stroke ( 6 , 14 ). In terms of all-cause mortality, a meta-analysis of the high-intensity vs. no statin and the high-intensity vs. low-to-moderate-intensity statin groups could not be conducted because no deaths occurred in the high-intensity group in one study ( 6 ) during the follow-up period ( Figures 3A,C ).…”

“…A major clinical trial, which demonstrated the effects of statins in patients with ischemic stroke, excluded patients with AF ( 1 ). Although several observational studies have reported that statins may be beneficial in patients with AF-related stroke, the results are inconclusive ( 12 – 14 ).…”