Statin Withdrawal Beyond Acute Phase Affected Outcome of Thrombolytic Stroke Patients

Tong, Lifang; Hu, Haitao; Zhang, Sheng; Yan, Shiyu; Lou, Min

doi:10.1097/md.0000000000000779

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…Preclinical studies have suggested that loss of anti-inflammatory and immunomodulatory effects of statins, so called pleiotropic effects, may increase the risk of CVD events also short term [ 9 , 13 , 14 , 15 ]. This theory is supported by a limited number of retrospective observational studies in patients where statin discontinuation increased the risk of worse outcomes [ 15 , 16 ]. Moreover, in a randomized controlled trial (RCT) of statin discontinuation ( n = 43) versus continuation ( n = 46) after acute ischemic stroke, discontinuation was associated with a significantly increased risk of death [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

et al. 2021

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Statin treatment is often terminated in patients with advanced cancer but guidelines for statin discontinuation are still lacking. The aim of this study was to investigate sex-differences in time-points of statin discontinuation in patients with advanced cancer. Medical records from 1535 deceased patients enrolled at a Palliative Home Care Unit were reviewed. A total of 149 patients (42 women and 107 men) who were diagnosed with cancer, and were treated with statins one year before death, were identified. Statin treatment was terminated earlier in women than in men, 3.0 months prior to death (IQR 0.88–7.25) as compared to 1.5 months (IQR 0.5–4.0) (p < 0.05), respectively. In a longitudinal analysis there was a significant difference between men and women still on statin treatment at all studied time-points, 9, 6, and 3 months before death (p < 0.05), where women terminated statin treatment earlier in the disease trajectory. Baseline demographics were similar between the sexes except that more men than women had a history of previous cardiovascular events (p < 0.01). However, neither the indication for statin treatment, i.e., primary prevention versus secondary prevention, nor age could explain the sex-difference in statin discontinuation. There was no difference in cardiovascular events or mortality between men and women after statin discontinuation.

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Section: Introductionmentioning

confidence: 99%

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

et al. 2021

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“…Risk of bias among the post-hoc analyses of RCTs and cohort studies was assessed with NOS. The results showed that 15 studies were graded as good quality ( 25 – 28 , 30 , 32 , 34 – 39 , 41 – 43 ) and the remaining 7 studies were graded as fair quality. The overall score of the NOS was 173 of 198 (87%), which is considered to represent an overall high quality.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies ( 24 – 27 , 30 , 31 , 35 , 38 , 41 ) involving 4,115 patients reported outcomes according to in-hospital statin use. The pooled estimates showed that in-hospital statin use was associated with a lower likelihood of symptomatic ICH (five studies, OR 0.46; 95% CI 0.21–1.00; p = 0.045; p for Cochran Q statistic = 0.88, I 2 = 0%; Figure 3A ; Table 3 ), any ICH (three studies, OR 0.51; 95% CI 0.27–0.98; p = 0.04; p for Cochran Q statistic = 0.53, I 2 = 0%; Figure 3B ; Table 3 ), and 3-month mortality (five studies, OR 0.42; 95% CI 0.29–0.62; p < 0.001; p for Cochran Q statistic = 0.44, I 2 = 0%; Figure 3C ; Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Statin Use and Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

Guo

Zhao

et al. 2021

Front. Neurol.

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Background: The data on the relationship between statin use and clinical outcomes after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) are in controversy.Objective: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of statins administered prior to onset and during hospitalization in patients with AIS treated with IVT.Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception until June 8, 2021. Comparative studies investigating statin effect on intracranial hemorrhage (ICH), functional outcomes, and mortality in adults with AIS treated with IVT were screened. Random-effect meta-analyses of odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were performed. The protocol was registered in PROSPERO (CRD42021254919).Results: Twenty-two observational studies were included, which involved 17,554 patients. The pooled estimates showed that pre-stroke statin use was associated with a higher likelihood of symptomatic ICH (OR 1.31; 95% CI 1.07–1.59; p = 0.008) and any ICH (OR 1.21; 95% CI 1.03–1.43; p = 0.02). However, the pre-stroke statin use was not significantly associated with the 3-month mortality, 3-month favorable functional outcome (FFO, modified Rankin Scale [mRS] score 0–1), and 3-month functional independence (FI; mRS score 0–2). However, in-hospital statin use was associated with a reduced risk of symptomatic ICH (OR 0.46; 95% CI 0.21–1.00; p = 0.045), any ICH (OR 0.51; 95% CI 0.27–0.98; p = 0.04), and 3-month mortality (OR 0.42; 95% CI 0.29–0.62; p < 0.001) and an increased probability of 3-month FFO (OR 1.33; 95% CI 1.02–1.744; p = 0.04) and 3-month FI (OR 1.41; 95% C, 1.11–1.80; p = 0.005).Conclusions: The present systematic review and meta-analysis suggests that in-hospital statin use after IVT may be safe and may have a favorable impact on clinical outcomes, a finding not observed in studies restricted to patients with pre-stroke statin use.

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“…A rise in the risk of adverse CV outcomes has been reported in patients discontinuing statin therapy [ 58 , 59 ]. A genetic predisposition has been hypothesized to be involved in the development of statin-induced muscle failure [ 60 ].…”

Section: Lipid-lowering Therapy (Llt)mentioning

confidence: 99%

Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update

et al. 2023

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It has been consistently demonstrated that circulating lipids and particularly low-density lipoprotein cholesterol (LDL-C) play a significant role in the development of coronary artery disease (CAD). Several trials have been focused on the reduction of LDL-C values in order to interfere with atherothrombotic progression. Importantly, for patients who experience acute coronary syndrome (ACS), there is a 20% likelihood of cardiovascular (CV) event recurrence within the two years following the index event. Moreover, the mortality within five years remains considerable, ranging between 19 and 22%. According to the latest guidelines, one of the main goals to achieve in ACS is an early improvement of the lipid profile. The evidence-based lipid pharmacological strategy after ACS has recently been enhanced. Although novel lipid-lowering drugs have different targets, the result is always the overexpression of LDL receptors (LDL-R), increased uptake of LDL-C, and lower LDL-C plasmatic levels. Statins, ezetimibe, and PCSK9 inhibitors have been shown to be safe and effective in the post-ACS setting, providing a consistent decrease in ischemic event recurrence. However, these drugs remain largely underprescribed, and the consistent discrepancy between real-world data and guideline recommendations in terms of achieved LDL-C levels represents a leading issue in secondary prevention. Although the cost-effectiveness of these new therapeutic advancements has been clearly demonstrated, many concerns about the cost of some newer agents continue to limit their use, affecting the outcome of patients who experienced ACS. In spite of the fact that according to the current recommendations, a stepwise lipid-lowering approach should be adopted, several more recent data suggest a "strike early and strike strong" strategy, based on the immediate use of statins and, eventually, a dual lipid-lowering therapy, reducing as much as possible the changes in lipid-lowering drugs after ACS. This review aims to discuss the possible lipid-lowering strategies in post-ACS and to identify those patients who might benefit most from more powerful treatments and up-to-date management.

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Statin Withdrawal Beyond Acute Phase Affected Outcome of Thrombolytic Stroke Patients

Cited by 7 publications

References 30 publications

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

Statin Use and Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update

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