Statin Adherence After Ischemic Stroke or Transient Ischemic Attack Is Associated With Clinical Outcome

Chen, Po Sheng; Cheng, Ching Lan; Yang, Yea Huei Kao; Li, Yi Heng

doi:10.1253/circj.cj-15-0753

Cited by 32 publications

(35 citation statements)

References 40 publications

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“…21 Statin adherence after ischemic stroke has been found to reduce the risk of a composite outcome of recurrent ischemic stroke, hemorrhagic stroke, or acute coronary event. 22 Despite the importance of statin adherence, previous reports have shown problematically low levels of average adherence in several different populations. 15,16,21,22 The cohort presented here had, by comparison, unusually high levels of overall statin adherence; it is possible that the right-shifted distribution of PDC shown in Figure 1A may be because of the integrated nature of the healthcare delivery system from which the data are derived.…”

Section: Discussionmentioning

confidence: 99%

“…22 Despite the importance of statin adherence, previous reports have shown problematically low levels of average adherence in several different populations. 15,16,21,22 The cohort presented here had, by comparison, unusually high levels of overall statin adherence; it is possible that the right-shifted distribution of PDC shown in Figure 1A may be because of the integrated nature of the healthcare delivery system from which the data are derived. Given that hospital discharge has been shown to be a critical moment to impact long-term adherence to the secondary stroke prevention strategies, 23 it is possible that our previously reported EMR intervention to increase statin prescription during stroke hospitalization 13 may have also contributed to long-term statin adherence in this cohort.…”

Section: Discussionmentioning

confidence: 99%

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Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Flint

Conell

Ren

et al. 2017

Stroke

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Background and Purpose-Outpatient statin use reduces the risk of recurrent ischemic stroke among patients with stroke of atherothrombotic cause. It is not known whether statins have similar effects in ischemic stroke caused by atrial fibrillation (AFib). Methods-We studied outpatient statin adherence, measured by percentage of days covered, and the risk of recurrent ischemic stroke in patients with or without AFib in a 21-hospital integrated healthcare delivery system. Results-Among 6116 patients with ischemic stroke discharged on a statin over a 5-year period, 1446 (23.6%) had a diagnosis of AFib at discharge. The mean statin adherence rate (percentage of days covered) was 85, and higher levels of percentage of days covered correlated with greater degrees of low-density lipoprotein suppression. In multivariable survival models of recurrent ischemic stroke over 3 years, after controlling for age, sex, race/ethnicity, medical comorbidities, and hospital center, higher statin adherence predicted reduced stroke risk both in patients without AFib (hazard ratio, 0.78; 95% confidence interval, 0.63-0.97) and in patients with AFib (hazard ratio, 0.59; 95% confidence interval, 0.43-0.81). This association was robust to adjustment for the time in the therapeutic range for international normalized ratio among AFib subjects taking warfarin (hazard ratio, 0.61; 95% confidence interval, 0.41-0.89). Conclusions-The relationship between statin adherence and reduced recurrent stroke risk is as strong among patients with AFib as it is among patients without AFib, suggesting that AFib status should not be a reason to exclude patients from secondary stroke prevention with a statin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Flint

Conell

Ren

et al. 2017

Stroke

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“…Of the six studies that reported incidence rates of stroke, four specifically reported rates of ischemic or TIA stroke 18,19,22,23 . All studies included patients on lipid-lowering therapy, while one additionally included patients with elevated LDL-C. Reported incidence of ischemic stroke ranged from 13.8 to 57. n/a n/a n/a n/a n/a n/a n/a n/a 27 , and an incidence rate of 15.5 (95% CI: 11.0-21.9) in statin-exposed secondary prevention CKD patients 28 .…”

Section: Ischemic Stroke/transient Ischemic Attack Ratesmentioning

confidence: 99%

Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review

Cherepanov

Bentley

Hsiao

et al. 2018

Current Medical Research and Opinion

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Objective: Based on randomized controlled trials (RCTs), non-fatal myocardial infarction (MI) rates range between 9 and 15 events per 1000 person-years, ischemic stroke between 4 and 6 per 1000 person-years, CHD death rates between 5 and 7 events per 1000 person-years, and any major vascular event between 28 and 53 per 1000 person-years in patients with atherosclerotic cardiovascular disease (ASCVD). We reviewed global literature on the topic to determine whether the real-world burden of secondary major adverse cardiovascular events (MACEs) is higher among ASCVD patients. Methods: We searched PubMed and Embase using MeSH/keywords including cardiovascular disease, secondary prevention and observational studies. Studies published in the last 5 years, in English, with 50 subjects with elevated low-density lipoprotein cholesterol (LDL-C) or on statins, and reporting secondary MACEs were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of each included study. Results: Of 4663 identified articles, 14 studies that reported MACE incidence rates per 1000 personyears were included in the review (NOS grades ranged from 8 to 9; 2 were prospective and 12 were retrospective studies). Reported incidence rates per 1000 person-years had a range (median) of 12.01-39.9 (26.8) for MI, 13.8-57.2 (41.5) for ischemic stroke, 1.0-94.5 (21.1) for CV-related mortality and 9.7-486 (52.6) for all-cause mortality. Rates were 25.8-211 (81.1) for composite of MACEs. Multiple event rates had a range (median) of 60-391 (183) events per 1000 person-years. Conclusions: Our review indicates that MACE rates observed in real-world studies are substantially higher than those reported in RCTs, suggesting that the secondary MACE burden and potential benefits of effective CVD management in ASCVD patients may be underestimated if real-world data are not taken into consideration. ARTICLE HISTORY

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“…13 In the SPARCL trial, a high-dose atorvastatin group had a higher incidence of hemorrhagic stroke than the control group. 3 On the contrary, in J-STARS, low-dose pravastatin therapy did not increase hemorrhagic stroke incidence.…”

mentioning

confidence: 99%

“…4 Chen et al report that only a limited number of patients (0.9%) received high-dose statin therapy while almost all other patients received low-dose (52.5%) or medium-dose statin therapy (46.7%). 13 Therefore, yperlipidemia is a well-known risk factor for ischemic stroke and cardiovascular disease, in addition to hypertension and diabetes mellitus. Previous clinical studies and meta-analyses have shown that appropriate therapy favorably reduces the incidence of both stroke and cardiovascular events.…”

mentioning

confidence: 99%

“Get With the Guideline” Treatment With Statin

Matsushima

Hosomi

2016

Circ J

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Statin Adherence After Ischemic Stroke or Transient Ischemic Attack Is Associated With Clinical Outcome

Cited by 32 publications

References 40 publications

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review

“Get With the Guideline” Treatment With Statin

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