Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke

Abstract

Background and Purpose-Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study. Methods-A population-based prospective cohort study was performed using rigorous ascertainment methods. Prestroke and acute (Յ72 hours) poststroke medications were recorded. Modified Rankin score and fatality were assessed at 7, 28, and 90 days and 1 year. Results-Of 448 ischemic stroke patients, statins were prescribed before stroke onset in 30.1% (134/445) and were begun acutely (Յ72 hours) in an additional 42.5% (189/445). On logistic regression analysis, adjusting for age, prestroke disability (modified Rankin scale), NIHSS score, hypertension, and aspirin, new poststroke statin therapy was independently associated with improved early and late survival (compared with statin untreated patients: OR for death, 0.12; CI, 0.03-0.54 at 7 days; OR, 0.19; CI, 0.07-0.48 at 90 days; OR, 0.26; CI, 0.12-0.55 at 1 year; PՅ0.006 for all). Similar findings were observed for statin therapy before stroke onset (adjusted OR for death compared with statin-untreated-patients, 0.04; CI, 0.00 -0.33; Pϭ0.003 at 7 days; OR, 0.23; CI, 0.09 -0.58; Pϭ0.002 at 90 days; OR, 0.48; CI, 0.23-1.01; Pϭ0.05 at 1 year). Conclusions-Statin therapy at stroke onset and newly begun statins were associated with improved early and late outcomes, supporting data from experimental studies. Randomized trials of statin therapy for treatment of acute stroke are needed. (Stroke. 2011;42:1021-1029.)Key Words: acute prescription Ⅲ acute stroke Ⅲ neuroprotectants Ⅲ outcomes Ⅲ statins I n randomized trials, 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) prevent stroke in survivors of first stroke and in other patients at high risk with vascular disease. 1,2 Statins also may improve outcomes after stroke. Infarct volume is reduced by pretreatment or early introduction of statin therapy in experimental acute stroke models. [3][4][5][6][7][8][9] In rodents, statin pretreatment has been associated with reduced neurological disability after focal brain ischemia. 4 -6 Rats treated with atorvastatin 24 hours after focal ischemia had enhanced neurological function, angiogenesis, synaptogenesis, and neuronal progenitor cell migration in the periinfarct region compared to controls. 10 Experimental data Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received July 12, 2010; accepted November 9, 2010 suggest that statins have vasodilatory, antithrombotic, antiinflammatory, antioxidant, and neuroprotective effects, which may mediate these benefits. 5-7,9 -11 Although providing some support for a neuroprotective role of statins in acute stroke, findings from clinical studies have been inconsistent. Whereas some observational studies have reported reduced mortality or improved functional outcomes in patients treated with statins before stroke on...

The THRombolysis and STatins (THRaST) study

“…20 In addition, our data also agree with previous observations in nonthrombolysed patients which showed that statin continuation in the acute phase of stroke, compared with discontinuation of previous treatment or no statin use, was associated with improved outcome and decreased risk of short-term neurologic deterioration and long-term death. 6,9 A weakness of the present study is that there were some intergroup imbalances in variables known to be related to unfavorable outcome after IV rtPA. Specifically, stroke severity and prevalence of atrial fibrillation were both higher in the no statin group, while prior antihypertensive use and history of hypercholesterolemia were higher in the statin group.…”

“…6 To date, very few studies have investigated the effect of statin use in the acute phase on ischemic stroke outcome. [7][8][9] The Stroke Prevention with Aggressive Reductions in Cholesterol Levels (SPARCL) trial showed a trend toward less severity for outcome 90 days after stroke with atorvastatin administration (80 mg), compared with placebo, in patients having a stroke during the trial. 10 So far, few studies have assessed the efficacy and safety of statin treatment in ischemic stroke patients treated with IV thrombolysis.…”

Statins after ischemic stroke of undetermined etiology in young adults

“…Furthermore, it has been shown that statins initiated before or immediately after ischemic stroke improved early and long-term survival and functional outcomes. 5 Second, higher serum total cholesterol and triglycerides are shown to be associated with better functional outcome and reduced long-term mortality after ischemic stroke, 3,4 but not with decreased risk for recurrent vascular events in the long term, which was the scope in our study. Third, our study included only patients with undetermined stroke etiology with no signs of smallvessel disease or any other probable or possible cause.…”

Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy

“…A population-based prospective cohort study found that initiation of new statin therapy (< 72 hours after stroke) was associated with improved 7-day survival, along with good functional outcomes at 7 days and 1 year. 69 Statin use initiated within 3 days of stroke hospitalization is strongly associated with improved poststroke survival. By contrast, withdrawal of statin therapy in the hospital was associated with worsened survival.…”