Statin therapy and outcome after ischemic stroke: Systematic review and meta-analysis of observational studies and randomized trials

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 PikijaJeffrey Probstfield, Natalia S. Rost, Amanda G. Thrift, Konstantinos Vemmos, Peter J. Kelly

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170 Citations (Scopus)

Abstract

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). CONCLUSION - : 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. © 2013 American Heart Association, Inc.
Original languageEnglish
Pages (from-to)448-456
JournalStroke
Volume44
Issue number2
DOIs
Publication statusPublished - 1 Feb 2013

Keywords

  • cerebral infarction
  • ischemia
  • neuroprotective agents
  • outcomes assessment
  • stroke
  • therapy

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