Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study

Abstract

BACKGROUND: Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes. METHODS: IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were combined from national registries on hospital admissions, mortality, cancer diagnoses, prescription medication purchases, and permissions for special reimbursements for medications. Usage of prescription medication was defined as drug purchase within 90 days after hospital discharge. Ongoing statin use during follow-up was analyzed in 90-day intervals. Differences in baseline features, comorbidities, other medications, and recanalization therapies were balanced with inverse probability of treatment weighting. Median follow-up was 5.7 years. RESULTS: Statin therapy was not used by 27.1% of patients within 90 days after IS discharge, with women and older patients using statins less frequently. The average proportion of patients without ongoing statin during the 12-year follow-up was 36.0%. Patients without early statins had higher all-cause mortality at 1 year (7.5% versus 4.4% in patients who did use statins; hazard ratio [HR], 1.74 [CI, 1.61–1.87]) and 12 years (56.8% versus 48.6%; HR, 1.37 [CI, 1.33–1.41]). Cumulative incidence of major adverse cerebrovascular or cardiovascular event was higher at 1 year (subdistribution HR, 1.36 [CI, 1.29–1.43]) and 12 years (subdistribution HR, 1.21 [CI, 1.18–1.25]) without early statin use. Cardiovascular death, recurrent IS, and myocardial infarction were more frequent without early statin use. Early statin use was not associated with hemorrhagic stroke during follow-up. Lack of ongoing statin during follow-up was associated with risk of death in time-dependent analysis (adjusted HR, 3.03 [CI, 2.96–3.23]). CONCLUSIONS: Lack of statin treatment after IS is associated with adverse long-term outcomes. Measures to further improve timely statin use after IS are needed.

Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia

“…Previous trials did not focus on this critical period, and recent randomized clinical trials did not show a significant effect on reducing the risk of new stroke . However, retrospective analyses and meta-analyses have suggested a positive effect on survival . In this large-scale randomized controlled trial, we did not find significant difference of the incidence of new stroke between immediate-intensive statin and delayed-intensive statin group within 72 hours of stroke onset, which is similar to the results of the Effects of Very Early Use of Rosuvastatin in Preventing Recurrence of Ischemic Stroke (EUREKA) study …”

The Impact of Atherosclerotic Burden on Vascular Outcomes in Patients with Stroke and Atrial Fibrillation: The ATHENA study

“… 23 , 24 In our study, patients with AVD were taking less oral anticoagulant therapy and more statins on admission, consistent with a prior study. 25 Despite these patients having higher cardiovascular risk, they tended to be undertreated and to have more severe strokes at admission. These patients deserve evidence-based treatment with NOACs as recommended by the guidelines.…”

Intensity of statin therapy after ischaemic stroke and long-term outcomes: a nationwide cohort study

“…Consecutive adult patients with IS (International Classification of Diseases 10 th revision primary diagnosis code I63) in Finland between 1 January 2005 to 30 June 2018 purchasing statins within 90 days following hospital discharge were retrospectively studied. 10 All hospitals treating patients with acute IS in mainland Finland were included in the study (20 hospitals, of which 5 university hospitals with neurosurgical facilities). 10 Patients were designated into study groups by the intensity of the first statin purchase after the index event.…”

“…10 All hospitals treating patients with acute IS in mainland Finland were included in the study (20 hospitals, of which 5 university hospitals with neurosurgical facilities). 10 Patients were designated into study groups by the intensity of the first statin purchase after the index event.…”

“…2 6 7 First randomised controlled trials evaluating statins after IS suggested an increase in risk for intracerebral haemorrhage (ICH) but later meta-analyses showed conflicting results. 8 9 Furthermore, large observational studies have shown neutral 10 or beneficial 11 effect of statins regarding the risk of ICH after stroke. 12 The risk of ICH might, however, depend on the statin intensity.…”