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Randomized Controlled Trial
. 2020 Jun 1;27(6):524-533.
doi: 10.5551/jat.51391. Epub 2019 Sep 25.

Effect of Statin on Stroke Recurrence Prevention at Different Infarction Locations: A Post Hoc Analysis of The J-STARS Study

Tomohisa Nezu  1 , Naohisa Hosomi  1 , Kazuo Kitagawa  2 , Yoji Nagai  3 , Yoko Nakagawa  4 , Shiro Aoki  1 , Tatsuo Kagimura  4 , Hirofumi Maruyama  1 , Hideki Origasa  5 , Kazuo Minematsu  6 , Shinichiro Uchiyama  7 , Masayasu Matsumoto  1   8 ; J-STARS collaborators
Affiliations
Randomized Controlled Trial

Effect of Statin on Stroke Recurrence Prevention at Different Infarction Locations: A Post Hoc Analysis of The J-STARS Study

Tomohisa Nezu et al. J Atheroscler Thromb. .

Abstract

Aim: Posterior circulation stroke (PCS) has different clinical features and prognosis compared with anterior circulation stroke (ACS), and whether the effect of statin therapy on stroke prevention differs according to infarction location remains unclear. This post hoc analysis of the J-STARS study aimed to compare the usefulness of statin at different infarction locations (i.e., ACS and PCS).

Methods: In the J-STARS study, 1578 patients were randomly assigned to the pravastatin or control group. The subjects were divided into two subgroups (ACS and PCS groups) based on the arteries responsible for the infarction. Cox proportional hazards models were used to investigate whether the all stroke recurrence rate was different between the ACS and PCS groups.

Results: The PCS group (n=499) had a significantly higher prevalence of diabetes than the ACS group (n=1022) (30.7% vs. 19.8%, P＜0.001). During the follow-up (4.9±1.4 years), the incidence of all stroke was significantly lower in the pravastatin group than in the control group among patients with PCS (adjusted hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.009); however, the stroke recurrence rates were not significantly different between both groups among patients with ACS (adjusted HR 1.32, 95% CI 0.93-1.88,P=0.123). A significant interaction between the ACS and PCS groups in terms of pravastatin effects was noted (P=0.003 for interaction).

Conclusions: Pravastatin significantly reduced the recurrence rate of all stroke among patients with PCS. Thus, the effect of statin on the recurrence of stroke may differ according to infarction location.

Keywords: Anterior circulation stroke; Posterior circulation stroke; Statin; Stroke prevention.

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Conflict of interest statement

Dr. Kitagawa reports personal fees from Daiichi Sankyo, during the conduct of the study; personal fees from Bayer Inc., Takeda Pharmaceutical, Nippon Boehringer Ingelheim, Kyowa Hakko Kirin, Sumitomo Dainippon Pharma, Astellas Pharma, and Sanofi, outside the submitted work; and grants from Daiichi Sankyo during the conduct of the study; grants from Bayer Inc., Takeda Pharmaceutical, Nippon Boehringer Ingelheim, Kyowa Hakko Kirin, Sumitomo Dainippon Pharma, Astellas Pharma, and Sanofi, outside the submitted work.

Dr. Maruyama reports grants from Grants-in-Aid for Scientific Research, Eisai, Pfizer, Otsuka Pharmaceutical, Shionogi, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Sanofi, and Astellas Pharma, outside the submitted work.

Dr. Minematsu reports personal fees from Bayer Yakuhin, Otsuka Pharmaceutical, Boehringer-Ingelheim, AstraZeneca, Pfizer, Mitsubishi Tanabe Pharma Corporation, Japan Stryker, Daiichi Sankyo, Astellas Pharma, Nippon Chemiphar, Fuji Film RI Pharma, CSL Behring, Medicos Hirata, EPS Corporation, HEALIOS K.K., and T-PEC Corporation, outside the submitted work.

Dr. Uchiyama reports personal fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Sanofi, Daiichi Sankyo, Dainippon Sumitomo, Astellas Pharma, AstraZeneca, Sannwa Kagaku, Shionogi, Mitsubishi Tanabe, and Pfizer, outside the submitted work.

Dr. Matsumoto reports personal fees from Kowa Pharmaceutical Co Ltd, Takeda Pharmaceutical Co Ltd, Bayer Yakuhin, Ltd, Sanofi KK, Daiichi Sankyo Co Ltd, Otsuka Pharmaceutical Co Ltd, Astellas Pharma Inc, Astra Zeneca KK, Mochida Pharmaceutical Co Ltd, Sumitomo Dainippon Pharma Co Ltd, Amgen Astellas BioPharma KK, Eisai Co Ltd, and Pfizer Japan Inc, outside the submitted work.

Ms. Nakagawa and Mr. Kagimura are employed at the Translational Research Informatics Center, which contracted with the J-STARS office as a data center and received a data center fee.

The other authors declare that they have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Kaplan–Meier curves for patients with anterior circulation stroke (A) and patients with posterior circulation stroke (B) from both the pravastatin and control groups The Cox proportional hazards model was applied by adjusting for stroke subtype (atherothrombotic stroke vs. others), high blood pressure (≥ 150/90 vs. < 150/90 mmHg), and diabetes mellitus (presence vs. absence). HR, hazard ratio; CI, confidence interval.
Supplemental Fig. 1.
Supplemental Fig. 1.
Exploratory analyses of the effects of pravastatin on all stroke recurrence in patients with anterior circulation stroke
Supplemental Fig. 2.
Supplemental Fig. 2.
Exploratory analyses of the effects of pravastatin on all stroke recurrence in patients with posterior circulation stroke
See this image and copyright information in PMC

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