Utilization of Statins Beyond the Initial Period After Stroke and 1‐Year Risk of Recurrent Stroke

Abstract

BackgroundIn‐hospital discontinuation of statins has been linked to poorer early stroke outcomes, but the consequences of postdischarge discontinuation or dose reduction of statin treatment are unknown. The objective of this study was to explore the effects of statin discontinuation or statin dose reduction on recurrent stroke risk.Methods and ResultsWe conducted a nationwide cohort study using the data from the Taiwan National Health Insurance Research Database. Our source population comprised all patients who were prescribed a statin within 90 days of discharge after an ischemic stroke between 2001 and 2012. Patients were categorized into 3 groups: statin‐discontinued, statin‐reduced, and statin‐maintained. Cox proportional hazard models were used to estimate the hazard ratios and 95%CIs of recurrent stroke during 1‐year follow‐up in the groups who discontinued statins or reduced statin dose compared with the group who maintained statins as the reference. Among the 45 151 ischemic stroke patients meeting criteria, during the day‐90 to day‐180 period, 7.0% were on reduced statin therapy, and 18.5% were not on any statin therapy. Compared with maintained‐statin intensity therapy, discontinuation of statins was associated with an increased hazard of recurrent stroke (adjusted hazard ratio 1.42, 95%CI 1.28‐1.57), whereas reduced‐statin dose was not associated with an additional risk (adjusted hazard ratio 0.94, 95%CI 0.78‐1.12). Propensity‐matching analysis obtained similar results.ConclusionsDiscontinuation of statin therapy between 3 and 6 months after an index ischemic stroke was associated with a higher risk of recurrent stroke within 1 year after statin discontinuation.

Transport Properties of Statins by Organic Anion Transporting Polypeptide 1A2 and Regulation by Transforming Growth Factor-β Signaling in Human Endothelial Cells

“…Our current work is focused on statins, which exhibit neuroprotective properties independent of their effects on circulating cholesterol (Fang et al, 2015;Zhang et al, 2009). Statins show clinical translation as evidenced by improved post-stroke recovery (Lee et al, 2017;Malhotra et al, 2019;Montaner et al, 2016). Another difference between statins and other compounds believed to be effective in stroke is that statins are known substrates for an endogenous BBB transporter (i.e., OATP1A2).…”

“…Indeed, 95% of published preclinical studies between 1990 and 2018 on novel neuroprotective drugs for stroke showed positive outcomes; however, none of these compounds have attained clinical success in a Phase III trial (Shi et al, 2018). In contrast, statin administration is associated with a lower degree of physical disability (Ishikawa et al, 2016;Malhotra et al, 2019) or reduced risk of recurrent stroke (Lee et al, 2017). Our work has demonstrated that Oatp1a4 can facilitate CNS delivery of both hydrophilic statins (i.e., pravastatin) and hydrophobic statins (i.e., atorvastatin) (Abdullahi et al, 2018).…”

Transporter-Mediated Delivery of Small Molecule Drugs to the Brain: A Critical Mechanism That Can Advance Therapeutic Development for Ischemic Stroke

“…Statins also improve outcomes in patients after stroke onset. For example, atorvastatin is associated with reduced risk of recurrent stroke in patients with a recent stroke or transient ischemic attack [102,103]. In a study of 104 patients receiving intravenous (i.v.)…”

The effect of statin use and intensity on stroke and myocardial infarction after carotid endarterectomy

“…8,9 Additionally, although high-intensity statin therapy has been suggested to decrease major adverse limb events in peripheral vascular disease, the effect of highintensity statin has not been compared with moderate intensity regimens in patients after CEA. 11 Some have suggested a possible increased benefit of high-intensity statin therapy in carotid disease, 12,[23][24][25][26][27] with some evidence of plaque stabilization as well as a decreased carotid intima media thickness. Yu et al 27 saw regression of carotid atherosclerotic disease with high-dose compared with low-dose atorvastatin.…”