Stroke severity and outcomes for octogenarians receiving statins

Phipps, Michael; Zeevi, Neer; Staff, Ilene; Fortunato, Gilbert; Kuchel, George A.; McCullough, Louise D.

doi:10.1016/j.archger.2013.05.007

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…In 3 of the 17 studies, prestroke statin was significantly associated with milder initial stroke severity or higher proportion of mild stroke [ 42 , 48 , 56 ]. Seven studies provided ORs with 95% CI (adjusted ORs in 5 studies and unadjusted ORs in 2 studies) [ 34 , 38 , 41 , 46 , 53 , 55 , 56 ]. Pooling 7 studies involving 6,806 patients showed that prestroke statin use was associated with milder stroke severity at stroke onset (OR, 1.24; 95% CI, 1.05-1.48; P= 0.013).…”

Section: Resultsmentioning

confidence: 99%

“…Three meta-analyses (outcome at 90 days outcome in 2 studies and discharge or 90 days in 1 study) [ 49 , 58 , 59 ] and 21 original articles (outcome at discharge or 7-10 days in 14 studies and at 90 days in 7 studies) [ 30 - 33 , 35 , 39 - 49 , 51 , 54 , 55 , 57 ] were identified and summarized in Table 2 . For functional outcome endpoint, modified Rankin Scale (mRS) 0-2 was most widely employed as a good outcome (12 studies: 10 original articles and 2 meta-analyses).…”

Section: Resultsmentioning

confidence: 99%

“…In 14 (12 original article and 2 meta-analyses) of the 24 studies, patients with prestroke statin were more likely to achieve good functional outcome. Pooling 19 original publications (involving 30,942 patien ts) [ 30 - 33 , 35 , 39 , 41 - 49 , 51 , 54 , 55 , 57 ], which provided adjusted ORs (95% CI), showed that prestroke statin use was associated with good functional outcome (OR, 1.50; 95% CI, 1.29-1.75; P <0.001). There was a significant and modest heterogeneity across the studies ( P =0.002, I 2 =55%).…”

Section: Resultsmentioning

confidence: 99%

“…Statin withdrawal effect was tested in one RCT performed in a single center [ 64 ], and explored in three observational studies ( Table 4 ) [ 51 , 52 , 55 ]. Of 3 studies assessing functional outcome (adjusted ORs for 90-day mRS 3-6 outcome in one study and for poor discharge disposition in 2 studies) [ 51 , 55 , 64 ], 2 studies showed that statin withdrawal was associated with poor outcome [ 51 , 64 ]. Pooling the 3 studies involving 13,583 patients showed that statin withdrawal was associated with poor functional outcome (OR, 1.83; 95% CI, 1.01-3.30; P =0.045).…”

Section: Resultsmentioning

confidence: 99%

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Statins in Acute Ischemic Stroke: A Systematic Review

2015

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Background and PurposeStatins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS). The current study aims to systematically review the statin effect in AIS.MethodsFrom literature review, we identified articles exploring prestroke and immediate post-stroke statin effect on imaging surrogate markers, initial stroke severity, functional outcome, and short-term mortality in human AIS. We summarized descriptive overview. In addition, for subjects with available data from publications, we conducted meta-analysis to provide pooled estimates.ResultsIn total, we identified 70 relevant articles including 6 meta-analyses. Surrogate imaging marker studies suggested that statin might enhance collaterals and reperfusion. Our updated meta-analysis indicated that prestroke statin use was associated with milder initial stroke severity (odds ratio [OR] [95% confidence interval], 1.24 [1.05-1.48]; P=0.013), good functional outcome (1.50 [1.29-1.75]; P<0.001), and lower mortality (0.42 [0.21-0.82]; P=0.0108). In-hospital statin use was associated with good functional outcome (1.31 [1.12-1.53]; P=0.001), and lower mortality (0.41 [0.29-0.58]; P<0.001). In contrast, statin withdrawal was associated with poor functional outcome (1.83 [1.01-3.30]; P=0.045). In patients treated with thrombolysis, statin was associated with good functional outcome (1.44 [1.10-1.89]; P=0.001), despite an increased risk of symptomatic hemorrhagic transformation (1.63 [1.04-2.56]; P=0.035).ConclusionsThe current study findings support the use of statin in AIS. However, the findings were mostly driven by observational studies at risk of bias, and thereby large randomized clinical trials would provide confirmatory evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Statins in Acute Ischemic Stroke: A Systematic Review

2015

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“…Most of the earlier studies have failed to detect the benefit of pre-stroke statin use on initial stroke severity [ 2 , 10 – 14 , 16 – 20 , 23 ]. However, except for two studies [ 16 , 19 ], they had a small sample size of less than 1000 and accordingly were not adequately powered to detect the pre-stroke statin effect on initial stroke severity.…”

Section: Discussionmentioning

confidence: 99%

Effect of pre-stroke statin use on stroke severity and early functional recovery: a retrospective cohort study

et al. 2015

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BackgroundExperimental studies suggest that pre-stroke statin treatment has a dual effect of neuroprotection during ischemia and neurorestoration after ischemic injury. The aim of this study was to evaluate the effect of pre-stroke statin use on initial stroke severity and early clinical outcome.MethodsWe used a prospective database enrolling patients with acute ischemic stroke from 12 hospitals in Korea between April 2008 and January 2012. Primary endpoint was the initial stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) score. Secondary endpoints were good outcome (modified Rankin Scale [mRS], 0–2) and overall mRS distribution at discharge. Multivariable regression model and propensity score (PS) matching were used for statistical analyses.ResultsAmong the 8340 patients included in this study, 964 patients (11.6 %) were pre-stroke statin users. The initial NIHSS score (mean [95 % CI]) was lower among pre-stroke statin users vs. non-users in multivariable analysis (5.7 [5.2–6.3] versus 6.4 [5.9–6.9], p = 0.002) and PS analysis (5.2 [4.7–5.7] versus 5.7 [5.4–6.0], p = 0.043). Pre-stroke statin use was associated with increased achievement of mRS 0–2 outcome (multivariable analysis: OR [95 % CI], 1.55 [1.25–1.92], p < 0.001; PS matching: OR [95 % CI], 1.47 [1.16-1.88]; p = 0.002) and favorable shift on the overall mRS distribution (multivariable analysis: OR [95 % CI], 1.29 [1.12-1.51], p = 0.001; PS matching: OR [95 % CI], 1.31 [1.11-1.54]; p = 0.001).ConclusionsPre-stroke statin use was independently associated with lesser stroke severity at presentation and better early functional recovery in patients with acute ischemic stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0376-3) contains supplementary material, which is available to authorized users.

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