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Statin therapy associated with improved stroke outcome

Statin therapy at stroke onset is associated with improved outcome, according to a study1 published recently in Stroke.

The authors performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischaemic stroke. The primary analysis investigated statin therapy at stroke onset (pre-stroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included acute post-stroke statin therapy (≤72 hours after stroke), and thrombolysis-treated patients.

The primary analysis included 113,148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (p <0.001), but not one year (p = 0.31), and with reduced fatality at 90 days (p <0.001) and one year (p = 0.01). In the single randomised controlled trial (RCT) reporting 90-day functional outcome, statin treatment was associated with good outcome (p = 0.05).

No reduction in fatality was observed on meta-analysis of data from three RCTs (p = 0.9). In studies of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02–1.52; p = 0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90–1.44; 4,012 patients).

Chronin

Dr Danielle Ní Chróinín

Study author Dr Danielle Ní Chróinín (Mater University Hospital/Dublin Academic Medical Centre, University College Dublin) spoke to BJC Arrhythmia Watch on the study’s key findings:

“We conducted a comprehensive systematic review and meta-analysis of observational studies and RCTs, exploring the association between statin therapy and outcomes following ischaemic stroke,” she said. “In our primary analysis, including data from over 113,000 patients, associations were seen between statin use at stroke onset (pre-stroke statin therapy), functional independence, and survival at up to one year following stroke, amongst observational studies.”

“In the single RCT for which data were available, a benefit for functional outcome was observed, but no benefit for survival was observed in RCTs. Acute post-stroke statin therapy (within 72 hours of stroke onset) was also associated with improved functional outcome and survival in observational studies, but not RCTs,” she continued

“These findings may represent a true benefit of statin therapy, as is supported by the consistency of benefit seen in observational and RCTs, the similar direction of findings with both statin therapy at stroke onset and acute post-stroke statin treatment, and evidence from animal stroke models, where benefits have also been described,” she added.

“However, we acknowledge the possibility of a prescribing bias, particularly in the case of post-stroke statin prescribing, and much of our data came from observational studies, which are subject to inherent limitations. Furthermore, we did not observe a benefit of statin therapy at stroke onset on analysis of studies restricted to thrombolysis-treated patients,” Dr Ní Chróinín said.

“We do not recommend routinely prescribing statins for acute neuroprotection, nor withholding thrombolysis in eligible statin-treated patients with acute ischaemic stroke. However, our findings provide the most comprehensive available data from clinical studies suggesting a relationship between statins and improved stroke outcome, underlining the need for large randomised trials to further investigate the efficacy and safety of statin therapy in acute ischaemic stroke,” she concluded.

References

1. Ní Chróinín D, Asplund K, Åsberg S, et al. Statin therapy and outcome after ischemic stroke systematic review and meta-analysis of observational studies and randomized trials. Stroke 2013. http://dx.doi.org/10.1161/STROKEAHA.112.668277

Published on: January 25, 2013

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