Document Detail


Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials.
MedLine Citation:
PMID:  23287777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke.
METHODS: The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤ 72 hours after stroke), and (2) thrombolysis-treated patients.
RESULTS: The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients).
CONCLUSIONS: In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.
Authors:
Danielle Ní Chróinín; Kjell Asplund; Signild Åsberg; Elizabeth Callaly; Elisa Cuadrado-Godia; Exuperio Díez-Tejedor; Mario Di Napoli; Stefan T Engelter; Karen L Furie; Sotirios Giannopoulos; Antonio M Gotto; Niamh Hannon; Fredrik Jonsson; Moira K Kapral; Joan Martí-Fàbregas; Patricia Martínez-Sánchez; Haralampos J Milionis; Joan Montaner; Antonio Muscari; Slaven Pikija; Jeffrey Probstfield; Natalia S Rost; Amanda G Thrift; Konstantinos Vemmos; Peter J Kelly
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-03
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  44     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-03-11     Revised Date:  2014-10-21    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  448-56     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / drug therapy*,  epidemiology,  mortality
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Randomized Controlled Trials as Topic / methods,  trends
Stroke / drug therapy*,  epidemiology,  mortality
Thrombolytic Therapy / methods*,  trends
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K23NS064052/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections
Comment In:
Stroke. 2013 Jun;44(6):e70   [PMID:  23592766 ]
J Pak Med Assoc. 2014 Jul;64(7):851   [PMID:  25255603 ]

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