The influence of statin withdrawal and adherence on stroke outcomes

Vitturi, Bruno Kusznir; Gagliardi, Rubens José

doi:10.1007/s10072-020-04790-y

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…Previous studies have shown that good adherence to statin therapy is associated with reduced risk of recurrent stroke, myocardial infarction, and all-cause death [7][8][9][10]. Satisfactory adherence to statins can also improve functional outcomes in persons with ischemic stroke [11]. However, adherence to long-term treatment of chronic disease decreases with time after diagnosis [12][13][14], and it has been shown that up to a third of statin users are non-adherent 6 months after their stroke event [15], even though improvement of statin adherence could reduce the risk of stroke [16].…”

Section: Introductionmentioning

confidence: 99%

Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

Norberg

Sjölander

Glader

et al. 2022

Eur J Clin Pharmacol

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Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence.

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Section: Introductionmentioning

confidence: 99%

Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

Norberg

Sjölander

Glader

et al. 2022

Eur J Clin Pharmacol

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“…However, statin intensity might have been influenced by underlying demographics, clinical presentation at admission, baseline lipid values, and physician’s preference. 28 , 29 Therefore, it is hard to detect the statin dosage effect. Third, the patients were not randomly assigned to either the statin-treatment or non-treatment group in our cohort study.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive Statin Therapy Reduces Mortality After Acute Hemorrhagic Stroke

Lin¹,

Chen²,

Wu³

et al. 2021

RMHP

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“…In addition, Lu et al also found that rosuvastatin combined with tissue plasminogen activator after stroke onset prevented the activation of astrocytes and microglia and reduced the release of inflammatory factors, thereby alleviating blood-brain barrier disruption and hemorrhagic transformation severity (50). However, in stroke patients receiving IVT, the beneficial effects have not been observed consistently in prior statin users, because the beneficial effects of statins may diminish after withdrawal (51,52), which is in agreement with one previous study (44). In addition, compared with statin treatment after thrombolysis, statin use before stroke significantly increased the fibrinolytic effect and disrupted homeostasis between coagulation and fibrinolysis (25).…”

Section: Discussionmentioning

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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The influence of statin withdrawal and adherence on stroke outcomes

Cited by 19 publications

References 28 publications

Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

Adjunctive Statin Therapy Reduces Mortality After Acute Hemorrhagic Stroke

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

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