Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease

Sicras‐Mainar, Antoni; Planas-Comes, Albert; Frias-Garrido, X; Navarro‐Artieda, Ruth; Salas-Cansado, Marina de; Rejas‐Gutiérrez, Javier

doi:10.1111/j.1365-2710.2011.01318.x

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…Such evidences need to be explored under normal daily clinical practice. We observed that statin therapy reduces stroke recurrence and improves survival, which were compatible with cohorts from Spain [17] and Japan [20]. However, the baseline LDL level among patients with and without recurrent stroke was similar in our study.…”

Section: Discussionsupporting

confidence: 88%

“…However, only 40.1% of patients were receiving statin at baseline and the mean LDL level (2.9 ± 0.7 mmol/L) was signi cantly beyond target. Although statin plays a key role in the medical therapy of secondary stroke prevention, studies have shown lower-than-expected statin treatment rates in the primary care with a prescription rates ranging from 29-37.7% [15][16][17]. The inadequate use of statin in our cohort was similar to those reported in North America and Europe.…”

Section: Discussionsupporting

confidence: 72%

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Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Han

Choi

Leung³

et al. 2020

Preprint

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Background: We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.Methods: A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1-30/6/2010) were enrolled. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. Risks of recurrent cardiovascular events and death were estimated by Cox proportional hazards model. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary heart disease (CHD).Results: A total of 466 patients (mean age, 71.5 years) were enrolled. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CHD. Age was an independent risk factor for recurrent stroke, CHD and death. Statin therapy at baseline had a protective effect for recurrent stroke (hazard ratio [HR] =0.454, 95% confidence interval [CI] 0.269-0.766, P=0.003) and all-cause mortality (HR= 0.693, 95% CI 0.486-0.968, P=0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.Conclusions: Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 72%

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Han

Choi

Leung³

et al. 2020

Preprint

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“…Treatments with general antioxidants (such as statins) are currently shown to be effective in both primary prevention (9,17,57,149,194) and recurrence of stroke (8,17,24,65,66,149). Clinical studies investigating ROS and NOX expression levels in circulating phagocytes from stroke patients might provide additional knowledge on the role of the molecules in stroke pathophysiology and solve some controversies (15,123,139).…”

Section: Potential Treatments For Humansmentioning

confidence: 99%

Pathophysiology and Treatments of Oxidative Injury in Ischemic Stroke: Focus on the Phagocytic NADPH Oxidase 2

Carbone

Teixeira

Braunersreuther

et al. 2015

Antioxidants & Redox Signaling

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Radical scavenger compounds (such as Ebselen and Edaravone) are under clinical investigation as a therapeutic approach against stroke. On the other hand, NOX inhibition might represent a promising strategy to prevent the stroke-related injury. Although selective NOX inhibitors are not yet available, nonselective compounds (such as apocynin and fasudil) provided encouraging results in preclinical studies. Whereas additional studies are needed to better evaluate this therapeutic potential in human beings, the development of specific NOX inhibitors (such as monoclonal antibodies, small-molecule inhibitors, or aptamers) might further improve brain recovery after stroke.

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“…In currently statin-treated ischemic stroke patients in Denmark, Ostergaard et al 26 reported rates of recurrent ischemic, hemorrhagic or unspecified stroke per 1000 person-years of 26.3 in current antiplatelet-treated patients, 32.8 in the recently treated antiplatelet patients, and 32.3 in the non-antiplatelet-treated patients. Among patients with prior stroke episode and with LDL-C of 100-190 mg/dL from six primary care centers and two hospitals in Spain, SicrasMainar et al 29 reported cumulative incidence rates per 1000 person-years for fatal and non-fatal ischemic and hemorrhagic stroke of 45.22 in non-statin users and 16.78 in statin users.…”

Section: Ischemic Stroke/transient Ischemic Attack Ratesmentioning

confidence: 99%

“…Two studies focused on stroke cohorts. In Sicras-Mainar et al 29 , all-cause mortality rates per 1000 person-years in stroke patients with elevated LDL-C were 36.25 and 26.09 in the no statins and statins groups, respectively. Among ischemic stroke patients stratified by antiplatelet and statin use in Ostergaard et al 26 , all-cause death rates per 1000 personyears were 38.2 (current antiplatelet), 36.9 (recent antiplatelet) and 50.7 (non-use antiplatelet).…”

Section: Mortalitymentioning

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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Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease

Abstract: Statin therapy in patients with first-ever acute stroke lowers the risk of 6-year stroke recurrence and improves survival in an aging Mediterranean cohort. These results add additional evidence in routine clinical practice to the observed effects of statins in clinical trials.

Cited by 9 publications

References 28 publications

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study

Pathophysiology and Treatments of Oxidative Injury in Ischemic Stroke: Focus on the Phagocytic NADPH Oxidase 2

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

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