<p>Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study</p>

Abstract

Background: Trial evidence supports statin use after ischemic stroke and recent American, European and British guidelines recommend high-intensity statins for this indication. Limited data are available describing current statin use among these patients in unselected settings. We conducted a cohort study to examine secular trends and factors associated with statin use and dose following ischemic stroke. Methods: A retrospective cohort study of patients with first ischemic stroke between 2000 and 2014 was conducted using the Clinical Practice Research Datalink (CPRD). Proportions of statin users and high-intensity statin users within 2 years after stroke were estimated for each calendar year. We used Cox regression models to explore potential factors associated with statin use and Poisson regression models to calculate risk ratios for the use of a high-intensity statin. Results: A total of 80,442 patients with first stroke were analyzed. The proportion using statins within 2 years after stroke increased from 25% in 2000 to 70% in 2006 and remained at about 75% through 2014. Among post-stroke statin users, high-intensity use accounted for approximately 15% between 2004 and 2011 and then increased to almost 35% in 2014. Older patients (aged ≥75 years), younger patients (<45 years), patients with no prior statin treatment, dementia, underweight, or absence of cardiovascular factors (coronary heart disease, smoking, obesity, diabetes, hypertension, or transient ischemic attack) were less likely to use statins and less likely to receive a high-intensity statin. Conclusion: There has been an increase over time in both statin use and dose, but many patients with ischemic stroke continue to be under-treated. Clinical trials and policy interventions to improve appropriate post-stroke statin use should focus on younger and older patients, patients with no pre-stroke statin treatment, and patients without additional cardiovascular risk factors.

Statin treatment and LDL target value achievement in Swiss general practice – a retrospective observational study

“…In our study, however, we found that a minority of these patients actually received high-intensity statin treatment. Underuse of high-intensity statin treatment is common in general practice [16][17][18], and several reasons may explain this finding. Statin-related sideeffects led to the discontinuation of treatment in 10% of patients [19], and Deshpande et al observed poorer patient adherence to high-intensity statin regimens when compared to lower intensity regimens [20].…”

Prevalence of Established Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in the UK

“…As a general precaution, diabetes patients with eCVD should be closely monitored for control of their metabolic parameters and risk factors. Contemporary evidence from CPRD suggests that only 75% of patients (with or without diabetes) receive lipid-lowering therapy after a stroke [16]. Diabetes has been associated with a slightly higher rate of statin utilization.…”

Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

“…For both smoking and BMI variables, the most recent data before the index stroke were used. Stroke subtype was classified into ischemic and hemorrhagic stroke (specific codes relating to ischemic stroke or unspecified stroke codes were regarded as ischemic stroke, considering these patients shared similar characteristics [ 19 ] and 90% of stroke in the UK is ischemic stroke [ 20 ]). Prior comorbidity was defined as the presence of any relevant Read code or ICD-10 code before the index stroke.…”