Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

Ovbiagele, Bruce; Saver, Jeffrey L.; Bang, Heejung; Chambless, Lloyd E.; Nassief, Abdullah; Minuk, Jeffrey; Toole, James F.; Crouse, John R.

doi:10.1212/01.wnl.0000208403.18885.0e

Cited by 39 publications

(24 citation statements)

References 34 publications

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“…4 This study and other evidence led the American Heart Association/American Stroke Association (AHA/ASA) to recommend in-hospital initiation of statin therapy for patients with stroke or transient ischemic attack (TIA) of atherosclerotic origin. 3 Before SPARCL, serum cholesterol management was underused in eligible patients with ischemic stroke and TIA, 5,6 and prior studies of lipid modifier treatment during the hospital encounter were based on regional, not nationwide data. Stroke hospitalization provides a window of opportunity to assure initiation of management 7 (http://stroke.ahajournals.org/cgi/ content/full/35/12/-R17-417899) and starting treatment during the acute stroke hospital encounter promotes drug adherence 8 and enhances clinical outcomes in the postdischarge setting.…”

mentioning

confidence: 99%

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Ovbiagele

Schwamm

Smith

et al. 2010

Stroke

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mentioning

confidence: 99%

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Ovbiagele

Schwamm

Smith

et al. 2010

Stroke

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“…In SALSA, the annual follow-up visits were conducted from 2000 to 2006, during which time there was a significant increase in statin use in the general population as well as an increase in statin use among the elderly, especially following the issuance of 2001 Adult Treatment Panel (ATP) III guidelines. 28 During this period, adherence to statin therapy was also reported to be improved for patients with high cardiovascular risk or with previous stroke, albeit still somewhat poor (Ͻ60% 6 months after initiation). 28 The data from our study reflect these trends including an increase in statin use (9% at baseline increasing to 26% at visit 4; see table 2) and adherence to therapy (58% used statins two or more follow-up periods of the study).…”

Section: Resultsmentioning

confidence: 93%

“…28 During this period, adherence to statin therapy was also reported to be improved for patients with high cardiovascular risk or with previous stroke, albeit still somewhat poor (Ͻ60% 6 months after initiation). 28 The data from our study reflect these trends including an increase in statin use (9% at baseline increasing to 26% at visit 4; see table 2) and adherence to therapy (58% used statins two or more follow-up periods of the study).…”

Section: Resultsmentioning

confidence: 93%

Use of Statins and Incidence of Dementia and Cognitive Impairment Without Dementia in a Cohort Study

Vos¹,

Nehrlich²,

Haan³

et al. 2009

Neurology

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Objective: Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up.Methods: Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND. Results:Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE 4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR ϭ 0.52; 95% CI 0.34, 0.80). Conclusion:Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes. Neurology The primary treatment benefit of statins is considered to be the reduction of low densitylipoprotein cholesterol (LDL-C) levels. [1][2][3][4][5][6][7][8] In most trials of cardiovascular morbidity/mortality, statin treatment was shown to reduce cardiovascular events 20% to 30%. [1][2][3][4][5][6] Other studies have indicated that statins have multiple actions beyond cholesterol lowering 7,9,10 ; these actions offer potential biologic mechanisms for the effect of statins on dementia.11 However, the evidence has been inconsistent about the relation of statin use and cognitive impairment. 12 The pattern of risk reductions seen in epidemiologic studies [13][14][15][16][17][18][19][20] continue to raise questions regarding the impact of statins on dementia. Earlier case-control studies [13][14][15] showed a protective effect of lipid lowering agents on the incidence of dementia. A later study 19 provided evidence that indication bias may have been present in the earlier reports. The second wave of observational Disclosure: Caryn Cramer was employed by Pfizer Corporation during completion of her doctoral degree during which time this study was conducted. Pfizer did not provide any material support for this study, and did not participate in the design, conduct, management, analysis, interpretation, review, or approval of the study or the manuscript. The other authors have reported no conflicts of inte...

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“…[22][23][24][25] For example, among 4888 outpatients enrolled in the Lipid Treatment Assessment Project, overall only 38% attained the LDL-cholesterol goal recommended by NCEP-ATP II. A Canadian study including ≈5000 high-risk ambulatory patients with CAD, CVD, or both found that <25% met LDL-guideline-recommended targets.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Directed Low-Density Lipoprotein Management in High-Risk Patients With Ischemic Stroke

Saposnik

Fonarow

Pan

et al. 2014

Stroke

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Because of an aging population and decreasing case fatality rate from improved medical care, there will be increasing numbers of survivors of stroke and myocardial infarction.3 As a result, clinicians will be exposed to more high-risk patients with CVD and cerebrovascular disease. Aggressive management of risk factors (including lifestyle modifications, antihypertensives, antithrombotics, and lipid-lowering therapy) is regarded as one of the most effective strategies to decrease the burden of CVD and cerebrovascular diseases. 4 Different scientific associations including the American Heart Association (AHA), and the American College of Cardiology, have established guidelines to stress the importance of risk-factor assessment and management. 5,6 During the past 2 decades, convincing evidence from clinical trials revealed the importance of low-density lipoprotein (LDL) cholesterol-lowering therapies in the reduction of cardiovascular morbidity and mortality.7-9 Furthermore, the benefits of treatment seem more pronounced among patients with establishedBackground and Purpose-Limited information is available on stroke prevention in high-risk patients with preexisting cardiovascular disease. Our aim was to use admission low-density lipoprotein (LDL) values to evaluate differences in the attainment of National Cholesterol Education Program-Adult Treatment Panel III guidelines goals at the time of the index event in high-risk patients with stroke and preexisting cardio-or cerebrovascular disease. Methods-Observational study, using data from the Get-With-The-Guidelines-Stroke Registry including 913 436 patients with an acute ischemic stroke or transient ischemic attack from April 2003 to September 2012. Participants were classified as high risk if they had history of transient ischemic attack (TIA), stroke (cardiovascular disease), and coronary artery disease (CAD). Results-Of the 913 436 patients admitted with an acute stroke or TIA, 194 557 (21.3%) had previous stroke/TIA, 148 833 (16.3%) had previous CAD, and 88 605 (9.7%) had concomitant CAD and cardiovascular disease. Overall, only 68% of patients with stroke were at their preadmission National Cholesterol Education Program III guideline-recommended LDL target; 51.3% had LDL <100 mg/dL; and only 19.8% had LDL<70 mg/dL. Among those presenting with a recurrent stroke, >45% had LDL>100 mg/dL. When compared with patients with CAD, patients with previous TIA/stroke were less likely to have LDL<100 or <70 mg/dL. In multivariable analysis, older age, men, white race, lack of major vascular risk factors, previous use of cholesterol-lowering therapy, and care provided in larger hospitals were associated with meeting LDL targets on admission testing. Conclusions-Management of dyslipidemia in high-risk patients with preexistent CAD or stroke continues to be suboptimal.Only 1 in 5 patients with prior TIA/stroke had LDL levels <70 mg/dL. (Stroke. 2014;45:3343-3351.)

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Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

Cited by 39 publications

References 34 publications

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Use of Statins and Incidence of Dementia and Cognitive Impairment Without Dementia in a Cohort Study

Guideline-Directed Low-Density Lipoprotein Management in High-Risk Patients With Ischemic Stroke

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