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Xu T, Wang Y, Yuan J, Chen Y. The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies. CNS Drugs 2021; 35:717-726. [PMID: 34019256 DOI: 10.1007/s40263-021-00829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several real-world observational studies have investigated the association between statin treatment and outcomes of cardioembolic stroke. However, substantial uncertainties remain about this association. OBJECTIVE We aimed to perform a systematic review and meta-analysis to determine the effect of statin treatment on the outcomes of cardioembolic stroke. METHODS We systematically searched the PubMed and Embase databases for relevant clinical studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) with a random-effects model were used to assess the outcomes of interest. RESULTS A total of 18 observational studies published between 2009 and 2020 were included. No randomized clinical trial was found. Compared with non-statin treatment, statin treatment was not associated with a decreased risk of stroke recurrence in patients with cardioembolic stroke [PWCS] (RR, 0.93; 95% CI 0.82-1.06). However, compared with non-statin treatment, statin treatment was associated with a lower risk of all-cause death (RR, 0.59; 95% CI 0.49-0.73) and better functional outcomes (RR, 0.67; 95% CI 0.47-0.97) in PWCS. There was no significant association between statin treatment and major bleeding event risk in PWCS (RR, 0.35; 95% CI 0.06-2.16). Compared with non-statin treatment, statin treatment was not associated with a decreased risk of coronary atherosclerotic disease in PWCS (RR, 1.04; 95% CI 0.96-1.11). CONCLUSIONS Although the use of statins does not enhance the prevention of stroke recurrence in PWCS, statin treatment is associated with improved clinical outcomes in PWCS. Statins play a beneficial role in the treatment of cardioembolic stroke.
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Affiliation(s)
- Tao Xu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - You Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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Yang X, Lu T, Qu Z, Zhang Y, Liu P, Ma Y. Plasma D-dimer level is associated with clinical outcomes in patients with atrial fibrillation related acute ischemic stroke after pneumonia. BMC Neurol 2021; 21:137. [PMID: 33773590 PMCID: PMC8004437 DOI: 10.1186/s12883-021-02168-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Pneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer. The aim of our study was to investigate the prognostic value of D-dimer for predicting clinical outcome of AF-related AIS with pneumonia. Method AF-related AIS patients with pneumonia were prospectively enrolled. Receiver operating characteristic (ROC) curve was used to determine the optimal D-dimer point for 3-month mortality and death/severe disability. The associations between the D-dimer and 3-month mortality and death/severe disability were assessed by multivariable logistic regression analysis. Results A total of 415 patients were enrolled in this study. ROC curve analysis showed that the optimal cut point of D-dimer for 3-month death/severe disability and mortality were D-dimer≥2.35 mg/l and D-dimer≥3.35 mg/l, respectively. Multivariable logistic regression analysis showed that D-dimer≥2.35 mg/l [adjusted odds ratio (aOR) 5.99, 95% confidence interval (CI): 3.04–11.83, P<0.001], higher NIHISS score (aOR:1.53, 95% CI: 1.38–1.69, P<0.001) and larger infarct volume (aOR 1.01, 95% CI: 1.01–1.02, P<0.001) were associated with increased risk of 3-month death/severe disability), and anticoagulant was associated with decreased risk of death/severe disability (aOR:0.21, 95% CI: 0.09–0.47, P<0.001). Higher NIHISS score (aOR:1.64, 95% CI: 1.38–1.94, P<0.001), older age (aOR 1.08, 95% CI: 1.02–1.14, P = 0.007), D-dimer≥3.35 mg/l (OR 8.49, 95% CI: 4.13–17.84,P<0.001), larger infarct volume (aOR 1.02, 95% CI: 1.00–1.03, P = 0.014), and higher CRUB-65 score (aOR 6.43, 95% CI: 3.10–13.34, P<0.001) were associated with increased risk of 3-month mortality. Conclusions AF-related AIS patients with concurrent high D-dimer and pneumonia increased risk of 3-month mortality and death/severe disability, plasma D-dimer may have predictive value in outcome after AF-related AIS with pneumonia.
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Affiliation(s)
- Xu Yang
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China.
| | - Taoli Lu
- Department of Neurology, Chengdu second people's hospital, Chengdu, 610015, Sichuan, China
| | - Zhanli Qu
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Yi Zhang
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Pingping Liu
- Department of Neurology, Nanchong Central Hospital; The Second Clinical Medical School, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Ying Ma
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
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Lu T, Yang X, Cai Y, Xie C, Zhang B. Prestroke Statins Improve Prognosis of Atrial Fibrillation-Associated Stroke through Increasing Suppressor of Cytokine Signaling-3 Levels. Eur Neurol 2021; 84:96-102. [PMID: 33684912 DOI: 10.1159/000513767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral infarction associated with atrial fibrillation (AF) has relatively higher mortality and morbidity rates than other types of stroke. Statins are being commonly prescribed to patients with stoke. However, the use of statins in AF-related stroke, especially prestroke, has not been well studied. This study aimed to investigate whether the use of prestroke statins could improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS) and its mechanism. METHODS This prospective study enrolled 453 AF-associated AIS patients from 4 medical centers and divided them into 2 groups based on the statin use before the stroke episode. All patients received comprehensive clinical examinations including 72-h Holter electrocardiogram monitoring and were followed up for 3 months. Plasma suppressor of cytokine signaling-3 (SOCS-3) and matrix metalloproteinase-9 (MMP-9) levels were measured by ELISA on admission and days 3 and 7 after enrollment. The endpoints were death, major disability (modified Rankin Scale score ≥3), and composite outcome (death/major disability) at 3 months after the AIS episode. RESULTS Plasma SOCS-3 levels were significantly increased and MMP-9 levels decreased in patients in the prestroke statin group on hospital admission and days 3 and 7 after enrollment (p < 0.001). Furthermore, our data suggested that baseline plasma SOCS-3 levels were associated with increased risk of 3-month mortality (adjusted odds ratio [OR], 1.012; 95% confidence interval [CI], 1.006-1.018; p < 0.001) and major disability (adjusted OR, 1.013; 95% CI, 1.007-1.02; p < 0.001). Similarly, baseline plasma MMP-9 levels were also associated with increased risk of 3-month mortality (adjusted OR, 1.037; 95% CI, 1.022-1.053; p < 0.001) and major disability (adjusted OR, 1.038; 95% CI, 1.022-1.55; p < 0.001). CONCLUSION Our data suggested that the prestroke use of statins improved the clinical outcomes in AIS patients with AF by upregulating the level of SOCS-3 and reducing the plasma MMP-9 level.
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Affiliation(s)
- Taoli Lu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, China,
| | - Xu Yang
- Department of Neurology, Nanchong Central Hospital, Nanchong, China
| | - Yanli Cai
- Department of Neurology, Ziyang First People's Hospital, Ziyang, China
| | - Chenchen Xie
- Department of Neurology, The Affiliated Hospital of Chengdu University, Chengdu, China
| | - Bei Zhang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, China
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Statin use and mortality in atrial fibrillation: A systematic review and meta-analysis of 100,287 patients. Pharmacol Res 2021; 165:105418. [PMID: 33450384 DOI: 10.1016/j.phrs.2021.105418] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/06/2020] [Accepted: 01/03/2021] [Indexed: 01/24/2023]
Abstract
Statins are effective for reducing cardiovascular disease in patients at risk or with cardiovascular disease. The benefit of statin therapy on adverse cardiovascular outcomes in patients with non-valvular atrial fibrillation (AF) is not clear. We performed a systematic review and meta-analysis of studies retrieved from MEDLINE via PubMed and Cochrane (CENTRAL) database of studies investigating the efficacy of statins in AF patients. The principal endpoint was all-cause mortality. Other endpoints were cardiovascular mortality, ischemic stroke, composite endpoints and any bleeding. We included 14 studies (2 post-hoc analysis of randomized clinical trials, 8 prospective and 4 retrospective) with 100,287 AF patients, of whom 23,228 were on statins. The pooled hazard ratio (HR) for all-cause mortality was 0.59 (95 % Confidence Interval [CI] 0.54-0.65). This association was consistent by aging, sex and prevalent cardiovascular or cerebrovascular disease. and the beneficial effect was evident already after 12 months of therapy. The absolute risk reduction for all-cause mortality in patients treated with statins was 10 % (95 % CI 9-10). The pooled HR for statins against cardiovascular mortality was 0.75 (95 % CI 0.58-0.96). No association was found with other secondary endpoints. Regarding bleeding events, the pooled HR for statin use was 0.60 (95 % CI 0.48-0.76). Our meta-analysis shows that in AF patients, statin therapy was associated with a reduction in all-cause and cardiovascular mortality are reduced by 41 % and 25 %, respectively. Randomized clinical trials in AF patients are necessary, as well as clarity on AF-specific LDL cholesterol targets.
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Eun MY, Jung JM, Choi KH, Seo WK. Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:589684. [PMID: 33162931 PMCID: PMC7581731 DOI: 10.3389/fneur.2020.589684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/11/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Statins lower the risk of recurrent stroke and mortality and improve outcomes in patients with ischemic stroke. However, the effects of statins on atrial fibrillation (AF)-related stroke are not well-established. Our study aims to investigate the effects of statin therapy on the clinical outcomes in patients with AF-related stroke. Methods: Electronic databases (MEDLINE, Embase, and Scopus) were searched for previous studies on the effects of pre- and post-stroke statins on the clinical outcomes in AF-related stroke patients. The primary outcome was all-cause mortality. Secondary outcomes included recurrent ischemic stroke, acute coronary events, major adverse cardiovascular events (MACE), and short-term functional outcomes. We extracted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (CI) from each study and pooled them through a meta-analysis. Results: A total of eight studies (five on post-stroke statins and three on pre-stroke statins) with 12,216 patients were included in the analysis. Post-stroke statin therapy reduced the risk of all-cause mortality (HR, 0.63; 95% CI, 0.55–0.74). This beneficial effect was sustained regardless of statin intensity. However, no significant associations were observed between statin therapy and a reduction in the risk of recurrent ischemic stroke, acute coronary events, or MACE. Pre-stroke statin use was associated with a lower risk of poor short-term functional outcomes (OR, 0.63; 95% CI, 0.47–0.85). Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.,Korea University Zebrafish Translational Medical Research Center, Ansan, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Ingrid L, von Euler M, Sunnerhagen KS. Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study. BMJ Open 2020; 10:e036159. [PMID: 32229526 PMCID: PMC7170610 DOI: 10.1136/bmjopen-2019-036159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objective was to investigate if there is a relationship between preischaemic stroke medicine use and health outcomes after stroke. SETTING This registry-based study covered Swedish stroke care, both primary and secondary care, including approximately 60% of the Swedish stroke cases from seven Swedish regions. PARTICIPANTS The Sveus research database was used, including 35 913 patients (33 943 with full information on confounding factors) with an ischaemic stroke (International Classification of Diseases, 10th Revision (ICD-10) I63*) between 2009 and 2011 registered both in the regions' patient administrative systems and in the Swedish Stroke Register. Patients with haemorrhagic stroke (ICD-10 I61*) were excluded. PRIMARY OUTCOME The primary outcome was the association, expressed in ORs, of prestroke medicine use (oral anticoagulants, statins, antihypertensives, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs) and antidiabetic drugs) and health outcomes 1 and 2 years poststroke (survival, activities of daily living dependency and modified Rankin Scale (mRS) 0-2), adjusted for patient characteristics and stroke severity at stroke onset. RESULTS The multivariate analysis indicated that patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants prestroke had worse odds for health outcomes in both survival (OR 0.65, 95% CI 0.60 to 0.69; OR 0.77, 95% CI 0.71 to 0.83; OR 0.72, 95% CI 0.66 to 0.80; OR 0.91, 95% CI 0.84 to 0.98, respectively, for survival at 2 years) and functional outcome (OR 0.82, 95% CI 0.75 to 0.89; OR 0.61, 95% CI 0.55 to 0.68; OR 0.83, 95% CI 0.72 to 0.95; OR 0.58, 95% CI 0.52 to 0.65, respectively, for mRS 0-2 at 1 year), whereas patients on statins and NSAIDS had significantly better odds for survival (OR 1.16, 95% CI 1.08 to 1.25 and OR 1.12, 95% CI 1.00 to 1.25 for 1-year survival, respectively), compared with patients without these treatments prior to stroke. CONCLUSIONS The results indicated that there are differences in health outcomes between patients who had different common prestroke treatments, patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants had worse health outcomes, whereas patients on statins and NSAIDS had significantly better survival, compared with patients without these treatments prior to stroke.
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Affiliation(s)
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
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Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke. BMC Neurol 2019; 19:240. [PMID: 31627722 PMCID: PMC6800490 DOI: 10.1186/s12883-019-1463-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72 h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score ≥ 3), and composite outcome (death/major disability) at 3 months after AIS. Results One hundred thirty-six patients were in no prestroke statins use group, and 106 in prestroke statins use group. Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P < 0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval (CI), 0.99–1.12; P = 0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P = 0.031)], major disability (adjusted OR, 0.38; 95% CI, 0.15–0.99; P = 0.047), and composite outcome (adjusted OR, 0.31; 95% CI, 0.17–0.74; P = 0.009). Conclusions Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.
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Dong S, Guo J, Fang J, Hong Y, Cui S, He L. Low-dose statin pretreatment reduces stroke severity and improves functional outcomes. J Neurol 2019; 266:2970-2978. [PMID: 31468121 DOI: 10.1007/s00415-019-09520-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/24/2019] [Accepted: 08/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Pre-stroke statin use reduces stroke severity and improves functional outcomes; however, whether low-dose statins as a primary preventive measure have similar effects on the Chinese population remains unclear. METHODS Consecutive cases of ischaemic stroke between May 2011 and January 2017 were retrospectively analysed. The primary endpoints were stroke severity on admission and functional outcomes at 90 days. The secondary endpoints were factors related to lower stroke severity on admission. Propensity score matching and logistic regression analyses were performed. RESULTS Of the 1878 patients, 6.4% and 23.8% were pre-stroke statin users before and after propensity matching, respectively, reducing the National Institutes of Health Stroke Scale (NIHSS) score on admission from 5 (2-9) to 3 (2-4) (P < 0.001). Patients receiving pretreatment with low-dose statins tended to have a better mRS distribution (median mRS score 2 [1-3] vs. 3 [2-4], P = 0.007) and a higher likelihood of favourable functional outcomes (FFOs) at 90 days (61 [65.6%] vs. 151 [50.8%], P = 0.005). The logistic regression analysis showed that low-dose statins taken before stroke (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.08-0.27, P < 0.001) and being male (OR = 0.81, 95% CI = 0.66-0.99, P = 0.035) were related to a lower stroke severity on admission but not among patients with atrial fibrillation (OR = 1.65, 95% CI = 1.12-2.44, P = 0.012) or elevated white blood cell (WBC) counts (OR = 1.12, 95% CI = 1.08-1.17, P < 0.001). CONCLUSIONS Pretreatment with low-dose statins reduced initial stroke severity, improved functional outcomes at 90 days and was independently associated with a lower stroke severity on admission among Chinese patients.
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Affiliation(s)
- Shuju Dong
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China
| | - Ye Hong
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China
| | - Shuhui Cui
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China
| | - Li He
- Department of Neurology, West China Hospital, Chengdu, Sichuan Province, China.
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Ho B, Lin Y, Lin S, Chou P, Chen C, Lin R, Hu H, Chao A. Statins and the risk of bleeding in patients taking dabigatran. Acta Neurol Scand 2019; 139:455-461. [PMID: 30742307 DOI: 10.1111/ane.13077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/08/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins. MATERIALS AND METHODS We performed a prospective, multicenter registry study of stroke patients with NVAF who initiated dabigatran therapy within 3 months after a clinically evident ischemic cerebrovascular event between 2013 and 2017. The main outcome measure was symptomatic bleeding after 90, 180, and 360 days. RESULTS In total, 652 patients (336 statin users, 316 non-users) were followed for 1 year after dabigatran therapy. Cox multivariate analysis demonstrated that male sex, prior use of aspirin, and concurrent use of an antiarrhythmic drug were associated with a higher risk of bleeding at 360 days. After adjusting time-dependent covariates, statin users had a significantly lower bleeding risk (adjusted hazard ratio: 0.11, P < 0.001) than non-users. Kaplan-Meier analysis indicated that patients prescribed with statins had a higher rate of bleeding-free survival (P = 0.028). CONCLUSION For secondary prevention of stroke in patients with NVAF who are taking dabigatran etexilate, co-prescription with a statin was associated with a lower risk of bleeding complications. Future research is needed to determine the pharmacological mechanism underlying this effect.
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Affiliation(s)
- Bo‐Lin Ho
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Neurology Kaohsiung Municipal Gangshan Hospital Kaohsiung Taiwan
| | - Ya‐Ju Lin
- Department of Neurology MacKay Memorial Hospital Taipei Taiwan
| | - Sheng‐Feng Lin
- School of Public Health, College of Public Health Taipei Medical University Taipei Taiwan
| | - Ping‐Song Chou
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Neurology, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Chien‐Fu Chen
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Ruey‐Tay Lin
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Neurology, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Han‐Hwa Hu
- Department of Neurology Taipei Medical University‐Shaung Ho Hospital Taipei Taiwan
- Graduate Institute of Clinical Medicine and Cerebrovascular Treatment and Research Center, College of Medicine Taipei Medical University Taipei Taiwan
| | - A‐Ching Chao
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Neurology, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
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Kotlęga D, Gołąb-Janowska M, Meller A, Bajer-Czajkowska A, Zembroń-Łacny A, Nowacki P, Banach M. Beneficial effects of pre-stroke statins use in cardioembolic stroke patients with atrial fibrillation: a hospital-based retrospective analysis. Arch Med Sci 2019; 15:385-392. [PMID: 30899291 PMCID: PMC6425215 DOI: 10.5114/aoms.2019.82925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/04/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Statins are widely used in stroke patients. The AHA/ASA guidelines recommend aggressive statin therapy in atherosclerotic stroke patients. Their beneficial effects are due to both their hypolipemic and pleiotropic properties. The aim of this study was to establish potential benefits from statin use in ischemic stroke patients with the diagnosis of atrial fibrillation (AF). MATERIAL AND METHODS Ischemic stroke patients with AF were enrolled in the study. Group I, the statin group (n = 181), consisted of patients who had been treated with statins before stroke. Group II, the non-statin group (n = 153), consisted of patients who had not received such treatment in the last year. In-hospital mortality and neurological deficit on admission and at discharge were analyzed using the National Institutes of Health Stroke Scale (NIHSS) score. RESULTS Patients from the non-statin group had greater initial and discharge NIHSS scores (10 vs. 11.9, probability value p < 0.05; 7.6 vs. 9.5, p < 0.05 respectively). The improvement in NIHSS score was greater in the statin group (73.5% vs. 59.5%, p < 0.01). In-hospital mortality was more frequent in the non-statin group (9.9% vs. 18.3%, p < 0.05). CONCLUSIONS Despite the predominant use of statins in atherothrombotic stroke patients, we demonstrated the beneficial effects of statins in cardioembolic stroke patients. Detailed cardiovascular screening for statin therapy should be carried out in all AF patients with regard to primary and secondary stroke prevention.
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Affiliation(s)
- Dariusz Kotlęga
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Agnieszka Meller
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, University of Zielona Gora, Zielona Gora, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Banach
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Zhu XC, Dai WZ, Ma T. Overview the effect of statin therapy on dementia risk, cognitive changes and its pathologic change: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:435. [PMID: 30596065 DOI: 10.21037/atm.2018.06.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Many studies have reported on the role of statin therapy in dementia, but its efficacy remains controversial. We aimed to search for reliable and meaningful articles to assess the efficacy of statin therapy for dementia risk, cognitive items, and pathologic markers. Methods Related literature for this study was published in the period from January 1, 1987 to January 1, 2018. Odds ratio (OR) and 95% confidence interval (95% CI) estimates were pooled in either fixed or random effects models. Results A total of 23 relevant studies were included after the application of the search strategy. The pooled results showed that statin therapy would downregulate dementia risk according to an analysis of 1,314,431 dementia patients and 1,836,539 healthy controls (OR: 0.64, 95% CI: 0.50, 0.81). In addition, specific changes in mini-mental state examination (MMSE) score were observed in individuals with dementia with statin therapy (OR: 0.46, 95% CI: 0.17, 0.74). However, the results of this meta-analysis showed that statin therapy did not significantly modify the Alzheimer's Disease Assessment Scale (ADAS-cog) score (OR: -0.26, 95% CI: -1.13, 0.62). No significant association was found between statin therapy and activities of daily living performance (OR: -0.69, 95% CI: -4.12, 2.74). When investigating pathological markers, our results indicated a significant influence of statin therapy on plasma amyloid β40 (Aβ40) (OR: 9.27, 95% CI: 0.71, 17.84), plasma Aβ42 (OR: 2.60, 95% CI: 1.07, 4.13), plasma low-density lipoprotein (LDL) cholesterol (OR: -16.95, 95% CI: -25.54, -8.37), plasma lathosterol (OR: -0.11, 95% CI: -0.14, -0.07), plasma 24s-hydroxycholesterol (OR: -10.41, 95% CI: -15.57, -5.25), and cerebrospinal fluid (CSF) lathosterol (OR: -0.07, 95% CI: -0.12, -0.01). Conclusions The available data indicate that statin therapy may reduce dementia risk, altering cognitive items and pathologic markers.
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Affiliation(s)
- Xi-Chen Zhu
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Wen-Zhuo Dai
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Tao Ma
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
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Kim YS, Park MS, Lee JH, Chung JW, Lee MJ, Kim CK, Jung JM, Oh K, Bang OY, Kim GM, Choi JM, Lee J, Chung CS, Lee KH, Seo WK. Effect of Statins on Survival Following Stroke in Patients With Cancer. Front Neurol 2018; 9:205. [PMID: 29740381 PMCID: PMC5928845 DOI: 10.3389/fneur.2018.00205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/15/2018] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to investigate the potential benefits of statin therapy initiation in acute stroke in patients with active cancer. This study was conducted in two parts. First, data from patients who are presented with stroke and active cancer were obtained from prospectively collected multicenter hospital-based stroke registries. Patients were classified into statin user and non-user groups; the statin group was further divided into low-potency and high-potency statin subgroups. The primary outcome was time to mortality. Second, we obtained data from the Korean National Health Information Service-National Sample Cohort (NHIS-NSC) database for external validation and analyzed the effect of statins on mortality, taking compliance into consideration. For the stroke registry cohort, statin use was independently associated with reduced mortality in a multivariable model [hazard ratio (HR) = 0.675, 95% confidence interval (CI) = 0.457–0.996]. There was no interaction between statin use and cancer characteristics, vascular risk factors, or laboratory findings. A dose-dependent relationship between statin use and survival was also demonstrated. Analysis of the NHIS-NSC database found a similar association between statin therapy and reduced mortality (adjusted HR = 0.64, 95% CI = 0.45–0.90) and this effect persisted even after controlling for the adherence of statin use (HR = 0.60, 95% CI = 0.41–0.89). Statin therapy could be associated with reduced mortality in patients with acute stroke and active cancer.
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Affiliation(s)
- Ye Sel Kim
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jun-Hwa Lee
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Kuro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Kuro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Geong-Moon Kim
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Ji-Mi Choi
- Department of Biostatics, Korea University College of Medicine, Seoul, South Korea
| | - Juneyoung Lee
- Department of Biostatics, Korea University College of Medicine, Seoul, South Korea
| | - Chin Sang Chung
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.,Department of Digital Health, The Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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Yan XH, Wu YQ. Study Progress of the Influence of Atrial Fibrillation Treatment on Dementia. Chin Med J (Engl) 2018; 131:859-861. [PMID: 29578132 PMCID: PMC5887747 DOI: 10.4103/0366-6999.228248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Use of statins and adverse outcomes in patients with atrial fibrillation: An analysis from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) general registry pilot phase. Int J Cardiol 2017; 248:166-172. [DOI: 10.1016/j.ijcard.2017.08.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/19/2023]
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