Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease

Chang, Chia-Hsuin; Lee, Yen-Chieh; Tsai, Chia Ti; Chang, Sheng‐Nan; Chung, Yi‐Chang; Lin, Mong-Wei; Lin, Jou‐Wei; Lai, Mei‐Shu

doi:10.1016/j.atherosclerosis.2013.11.036

Cited by 123 publications

(100 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Statins stabilize plaques in arteries supplying brain and heart, reducing the risk of recurrent cerebral infarction and coronary artery disease–related events 13. Also, statin cessation has been associated with reduced flow‐mediated vasodilation, increased atrial fibrillation, and elevated C‐reactive protein serum levels 14, 15, 16…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Saver

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundIn‐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 ResultsWe 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.ConclusionsDiscontinuation 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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Lee

Saver

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…9,10,15 The diagnostic accuracy of AF using this definition in NHIRD has been previously validated. 16,17 Among the study population, there were 124 271 patients who did not receive warfarin or any antiplatelet agents, including aspirin, clopidogrel, dipyridamole, and ticlopidine, in whom the diagnostic accuracies of CHA 2 DS 2 -VASc and mCHA 2 DS 2 -VASc scores in predicting ischemic stroke were compared. Among the whole study population (n=224 866), 15 948 patients had a CHA 2 DS 2 -VASc score of 0 (males) or 1 (females), and 8654 patients had a mCHA 2 DS 2 -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold.…”

Section: Study Cohortmentioning

confidence: 99%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

View full text Add to dashboard Cite

A trial fibrillation (AF) confers a 5-fold increased risk of stroke compared with patients without AF. 1 The risk of AF-associated stroke is not homogeneous and depends on patients' age and comorbidities, which have resulted in the development of clinical scores to aid stroke risk stratification and guide the use of oral anticoagulation (OAC) for stroke prevention. Currently, the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) score is recommended by guidelines for stroke risk stratification in AF 2,3 and has been shown to be better than the older CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score for stroke risk stratification among Asian AF patients. 4 Because age is an important driver of ischemic stroke for AF patients, 5 the CHA 2 DS 2 -VASc scheme assigns 1 point forBackground and Purpose-The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA 2 DS 2 -VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA 2 DS 2 -VASc score for stroke risk stratification in Asians. Methods-This study used the Taiwan National Health Insurance Research Database, which included 224 866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA 2 DS 2 -VASc and mCHA 2 DS 2 -VASc scores were compared among 124 271 patients without antithrombotic therapies. From the whole cohort, 15 948 patients had a CHA 2 DS 2 -VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA 2 DS 2 -VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared. Results-During a follow-up of 538 653 person-years, 21 008 patients experienced ischemic stroke. The mCHA 2 DS 2 -VASc performed better than CHA 2 DS 2 -VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA 2 DS 2 -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models. patients aged between 65 and 74 years and 2 points for those aged ≥75 years. 6 However, the age threshold for an increased risk of ischemic stroke for Asians may be lower than that of Caucasians. Conclusions-In7 For Asian AF patients with a CHA 2 DS 2 -VASc score of 0 (males)...

show abstract

“…First, the diagnosis of AF and the occurrence of ischemic stroke were based on the diagnostic codes registered by the physicians responsible for the treatment of patients; nonetheless, the accuracy of the diagnosis of AF and ischemic stroke in Taiwan's NHIRD has been validated previously as high 12, 13, 15, 16. We defined patients as having AF only when it was a discharge diagnosis or was confirmed on at least 2 occasions in the outpatient department.…”

Section: Discussionmentioning

confidence: 99%

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?

Hung

Chao

Liu

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundRecent studies demonstrated that oral anticoagulants (OACs) should be considered for patients with atrial fibrillation and 1 risk factor in addition to sex. Because age is an important determinant of ischemic stroke, the strategy for stroke prevention may be different for these patients in different age strata. The aim of this study was to investigate whether OACs should be considered for patients aged 20 to 49 years with atrial fibrillation and a CHA2DS2‐VASc score of 1 (men) or 2 (women).Methods and ResultsUsing the Taiwan National Health Insurance Research Database, 7374 male patients with atrial fibrillation and a CHA2DS2‐VASc score of 1 and 4461 female patients with atrial fibrillation and a CHA2DS2‐VASc score of 2 and all without antithrombotic therapies were identified and stratified into 3 groups by age. The threshold for the initiation of OACs for stroke prevention was set at a stroke rate of 1.7% per year for warfarin and 0.9% per year for non–vitamin K antagonist OACs. Among male patients aged 20 to 49 years with a CHA2DS2‐VASc score of 1, the risk of ischemic stroke was 1.30% per year and ranged from 0.94% per year for those with hypertension to 1.71% for those with congestive heart failure. Among female patients aged 20 to 49 years with a CHA2DS2‐VASc score of 2, the risk of ischemic stroke was 1.40% per year and ranged from 1.11% per year for those with hypertension to 1.67% for those with congestive heart failure.ConclusionsFor atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.

show abstract

Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease

Cited by 123 publications

References 36 publications

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

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

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?

Contact Info

Product

Resources

About

Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease

Cited by 123 publications

References 36 publications

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

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

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA 2 DS 2 ‐VASc Score of 1 (Men) or 2 (Women)?

Contact Info

Product

Resources

About

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?