Association between Statin Use and Short-Term Outcome Based on Severity of Ischemic Stroke: A Cohort Study
et al. (2014) Association between Statin Use and Short-Term Outcome Based on Severity of Ischemic Stroke: A
Cohort Study. PLoS ONE 9(1): e84389. doi:10.1371/journal.pone.0084389
Association between Statin Use and Short-Term Outcome Based on Severity of Ischemic Stroke: A Cohort Study
Bo Song. 0
Yilong Wang 0
Xingquan Zhao 0
Liping Liu 0
Chunxue Wang 0
Anxin Wang 0
Wanliang Du 0
Jean-Claude Baron, INSERM, Paris, France
0 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , China
Background: Statins reportedly improve clinical outcomes for ischemic stroke patients. However, it is unclear whether the contribution of statin treatment varies depending on the severity of stroke. We sought to investigate the relationship between statin use and the outcome of acute first-ever ischemic stroke patients stratified by stroke severity. Methods: A total of 7,455 acute first-ever ischemic stroke patients without statin treatment before onset were eligible from the China National Stroke Registry. A National Institutes of Health Stroke Scale (NIHSS) score of 0 to 4 was defined as minor stroke, and a NIHSS score of .4 was defined as non-minor stroke. We analyzed the association between statin use during hospitalization and mortality as well as functional outcome (measured by a modified Rankin Scale score of 0-5) at 3 months after onset using multivariable logistic regression models. Results: A total of 3,231 (43.3%) patients received statin treatment during hospitalization. Multivariable analysis showed that statin use during hospitalization decreased mortality of ischemic stroke patients (OR, 0.51; 95%CI, 0.38-0.67), but did not improve poor functional outcomes (OR, 0.95; 95CI%, 0.81-1.11) at 3 months. The interaction between statin use and stroke severity was significant both in dependence and death outcome (P = 0.04 for dependence outcome, P = 0.03 for death outcome). After stratification by stroke severity, statin use during hospitalization decreased the mortality of stroke (OR, 0.44; 95%CI, 0.31-0.62) and poor functional outcome (OR, 0.73; 95%CI, 0.57-0.92) at 3 months in the non-minor stroke group. Conclusions: Statin use during hospitalization may improve the clinical outcome of acute first-ever ischemic stroke depending on the severity of stroke. Non-minor stroke patients may obtain benefit from statin treatment with improvements in poor functional outcomes and mortality.
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. These authors contributed equally to this work.
Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme
reductase and have potential pleiotropic effects on stroke in
addition to their lipid-lowering properties. Many observational
studies have revealed that statin use before or after stroke onset
can decrease mortality[13] and improve short-term[46] and
long-term[78] outcomes of ischemic stroke. Statin use during
hospitalization on ischemic stroke and transient ischemic attack
(TIA) patients can decrease the recurrence of composite outcomes
including stroke, ischemic heart disease, and all-cause death.[9] In
addition, discontinuation of statins after ischemic stroke may lead
to unfavorable outcomes.[10]
Researches revealed that the clinical outcome of ischemic stroke
patients depended on stroke severity, and minor stroke patients
had a better prognosis.[1113] There was only one study focused
on clinical outcome of statin treatment to the minor stroke or TIA.
This randomized controlled study, Fast assessment of stroke and
transient ischemic attack to prevent early recurrence (FASTER),
including 396 individuals, showed that simvastatin use did not
affect mortality or functional outcomes of minor stroke and TIA
patients.[14] Therefore, it is worthwhile to speculate whether
statin treatment has any clinical effect on the outcome of ischemic
stroke or whether the association between statin treatment and
outcome varies depending on stroke severity. There have been no
reports involving a Chinese population on this topic. In the present
study, we assessed the association between statin therapy during
hospitalization and the outcome of acute first-ever ischemic stroke
based on the data of the China National Stroke Registry
(CNSR).[15]
Figure 1. Flow diagram defining the potentially eligible patients with acute stroke for statins treatment.
doi:10.1371/journal.pone.0084389.g001
Subjects and Methods
Data source
The CNSR is a nationwide, prospective, hospital-based registry
aimed at evaluating risk factors, clinical characteristics, treatment,
prevention status survey, and prognosis of acute stroke from
September 2007 to August 2008 in China. Detailed information of
the design of the CNSR registry has been previously
published.[1516]
Trained physicians recorded all information of enrolled stroke
patients, including demography, vascular risk factors, clinical
manifestations, the National Institutes of Health Stroke Scale
(NIHSS) score,[17] laboratory examinations, clinical diagnosis,
treatment, secondary pre (...truncated)