Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil

Abstract

<jats:p>ABSTRACT Background: Statin therapy has become one of the most important advances in stroke secondary prevention. Objective: To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. Methods: We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. Results: Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. Conclusions: Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.</jats:p>

Effect of lipid-lowering Medications in patients with coronary artery bypass grafting surgery outcomes

“…Postoperative stroke in cardiac surgery patients increases morbidity and mortality [42,43]. Evidence has shown that statins can exert multidirectional effects, interfering with reactive oxygen species development, clot formation, endothelial function, and brain plasticity which might play an essential role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance [44]. Another study also con rmed the effect of statin-based therapy for primary and secondary prevention of ischemic stroke [45].…”

Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes

“…Postoperative stroke in cardiac surgery patients increases morbidity and mortality [ 42 , 43 ]. Evidence has shown that statins can exert multidirectional effects, interfering with reactive oxygen species development, clot formation, endothelial function, and brain plasticity which might play an essential role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance [ 44 ]. Another study also confirmed the effect of statin-based therapy for primary and secondary prevention of ischemic stroke [ 45 ].…”

A Dynamic Nomogram to Predict the 3-Month Unfavorable Outcome of Patients with Acute Ischemic Stroke

“…External validation in other stroke centers is necessary due to the differences of race, patient’s wealth, hospital type and ischemic stroke treatments. Third, risk factors excluded in our study, such as collateral circulation and different drug treatments (statins, 41 antiplatelets 42 and anticoagulants 43 ), are likely to be important for predicting unfavorable outcomes, which may damper the rigor and scientific nature of the prediction model and limit its extensive application in clinic. Despite these limitations, our nomogram based on easily available variables may be widely used.…”