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

Abstract

Background: Statins lower the risk of recurrent stroke and mortality and improve outcomes in patients with ischemic stroke. However, the effects of statins on atrial fibrillation (AF)-related stroke are not well-established. Our study aims to investigate the effects of statin therapy on the clinical outcomes in patients with AF-related stroke. Methods: Electronic databases (MEDLINE, Embase, and Scopus) were searched for previous studies on the effects of pre- and post-stroke statins on the clinical outcomes in AF-related stroke patients. The primary outcome was all-cause mortality. Secondary outcomes included recurrent ischemic stroke, acute coronary events, major adverse cardiovascular events (MACE), and short-term functional outcomes. We extracted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (CI) from each study and pooled them through a meta-analysis. Results: A total of eight studies (five on post-stroke statins and three on pre-stroke statins) with 12,216 patients were included in the analysis. Post-stroke statin therapy reduced the risk of all-cause mortality (HR, 0.63; 95% CI, 0.55–0.74). This beneficial effect was sustained regardless of statin intensity. However, no significant associations were observed between statin therapy and a reduction in the risk of recurrent ischemic stroke, acute coronary events, or MACE. Pre-stroke statin use was associated with a lower risk of poor short-term functional outcomes (OR, 0.63; 95% CI, 0.47–0.85). Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.

Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Detection in Acute Ischemic Stroke Patients

“…Data from the literature also point to the role of statins in the treatment of AF-related stroke patients. Poststroke statin therapy reduced the risk of all-cause mortality [50]. In-hospital mortality is significantly higher in the AF-related stroke patients not taking statins before hospitalization than in those who did [51].…”

Pre-Stroke Statin Therapy Improves In-Hospital Prognosis Following Acute Ischemic Stroke Associated with Well-Controlled Nonvalvular Atrial Fibrillation

“…In a meta-analysis by Biffi et al, the use of statins prior to a stroke is shown to be correlated with better outcomes for small vessel strokes than any other stroke subtype [ 41 ]. Another meta-analysis by Eun et al shows that the use of statins before AF-related stroke is associated with a lower risk of poor short-term functional outcomes [ 42 ].…”

Hydrophilic or Lipophilic Statins?

“…The possible differences between statin types and the risk of atrial fibrillation related stroke has also been evaluated. In this sense, a meta-analysis ( 66 ) including a total of 8 studies evaluated the clinical outcomes both for pre- and post-stroke statins. They observed that post-stroke statin therapy reduced total mortality regardless of statin intensity.…”