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

Abstract

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.

Medication Adherence of Statin Users after Acute Ischemic Stroke

“…Adherence to statin medication was associated with lower risk of recurrent ischemic stroke, hemorrhagic stroke, and acute coronary events 1 year after statin initiation in patients with ischemic stroke or TIA [22]. Another study suggested that the relationship between statin adherence and reduced recurrent stroke risk is similar regardless of atrial fibrillation status [23]. Recent reports using nationwide health claim data in South Korea showed that good adherence was associated with lower risk of CV events [24].…”

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…[104][105][106] In randomized controlled trials (RCTs), statins reduced the incidence of new-onset as well as recurrent AF; 107-109 their use is also associated with a decrease in AF-related thromboembolic events. 110,111 At the same time, the use of statins is followed by an improvement in abnormal diastolic filling dynamics [112][113][114] as well as by reduced risk for new-onset HF with the features of HFpEF. 115,116…”

Practicing Evidence-Based Stroke Medicine

“…A recent observational study from a large database evaluated the risk of recurrent stroke in patients with or without atrial fibrillation who took statins after their stroke. 13 The risk of recurrent stroke was strongly related to adherence with the statin prescription and adherence in both groups, suggesting that statins may reduce recurrent stroke risk in stroke related to atrial fibrillation. Though intriguing, this study is not definitive, and the results may have been affected by bias and confounding.…”