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Observational Study
. 2017 Aug 2;6(8):e005658.
doi: 10.1161/JAHA.117.005658.

Utilization of Statins Beyond the Initial Period After Stroke and 1-Year Risk of Recurrent Stroke

Meng Lee  1 , Jeffrey L Saver  2 , Yi-Ling Wu  3 , Sung-Chun Tang  4 , Jiann-Der Lee  5 , Neal M Rao  2 , Hui-Hsuan Wang  6 , Jiann-Shing Jeng  4 , Tsong-Hai Lee  7 , Pei-Chun Chen  8 , Bruce Ovbiagele  9
Affiliations
Observational Study

Utilization of Statins Beyond the Initial Period After Stroke and 1-Year Risk of Recurrent Stroke

Meng Lee et al. J Am Heart Assoc. .

Abstract

Background: In-hospital discontinuation of statins has been linked to poorer early stroke outcomes, but the consequences of postdischarge discontinuation or dose reduction of statin treatment are unknown. The objective of this study was to explore the effects of statin discontinuation or statin dose reduction on recurrent stroke risk.

Methods and results: We conducted a nationwide cohort study using the data from the Taiwan National Health Insurance Research Database. Our source population comprised all patients who were prescribed a statin within 90 days of discharge after an ischemic stroke between 2001 and 2012. Patients were categorized into 3 groups: statin-discontinued, statin-reduced, and statin-maintained. Cox proportional hazard models were used to estimate the hazard ratios and 95%CIs of recurrent stroke during 1-year follow-up in the groups who discontinued statins or reduced statin dose compared with the group who maintained statins as the reference. Among the 45 151 ischemic stroke patients meeting criteria, during the day-90 to day-180 period, 7.0% were on reduced statin therapy, and 18.5% were not on any statin therapy. Compared with maintained-statin intensity therapy, discontinuation of statins was associated with an increased hazard of recurrent stroke (adjusted hazard ratio 1.42, 95%CI 1.28-1.57), whereas reduced-statin dose was not associated with an additional risk (adjusted hazard ratio 0.94, 95%CI 0.78-1.12). Propensity-matching analysis obtained similar results.

Conclusions: Discontinuation of statin therapy between 3 and 6 months after an index ischemic stroke was associated with a higher risk of recurrent stroke within 1 year after statin discontinuation.

Keywords: ischemic stroke; secondary prevention; statin; stroke; stroke prevention.

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Figures

Figure 1
Figure 1
A flowchart of the study process.
Figure 2
Figure 2
Stratified analysis for recurrent stroke according to baseline characteristics, by propensity score matching: (A) statin‐maintained vs statin‐discontinued; (B) statin‐maintained vs statin‐reduced.
See this image and copyright information in PMC

References

    1. Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta‐analysis of statins for stroke prevention. Lancet Neurol. 2009;8:453–463. - PubMed
    1. Amarenco P, Bogousslavsky J, Callahan A III, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA; Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators . High‐dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–559. - PubMed
    1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd‐Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF; American College of Cardiology/American Heart Association Task Force on Practice Guidelines . 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–S45. - PubMed
    1. Hong KS, Lee JS. Statins in acute ischemic stroke: a systematic review. J Stroke. 2015;17:282–301. - PMC - PubMed
    1. Gomez Sandoval YH, Braganza MV, Daskalopoulou SS. Statin discontinuation in high‐risk patients: a systematic review of the evidence. Curr Pharm Des. 2011;17:3669–3689. - PubMed

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