TY - JOUR
T1 - Statin therapy and outcome after ischemic stroke
T2 - Systematic review and meta-analysis of observational studies and randomized trials
AU - Ní Chróinín, Danielle
AU - Asplund, Kjell
AU - Åsberg, Signild
AU - Callaly, Elizabeth
AU - Cuadrado-Godia, Elisa
AU - Díez-Tejedor, Exuperio
AU - Di Napoli, Mario
AU - Engelter, Stefan T.
AU - Furie, Karen L.
AU - Giannopoulos, Sotirios
AU - Gotto, Antonio M.
AU - Hannon, Niamh
AU - Jonsson, Fredrik
AU - Kapral, Moira K.
AU - Martí-Fàbregas, Joan
AU - Martínez-Sánchez, Patricia
AU - Milionis, Haralampos J.
AU - Montaner, Joan
AU - Muscari, Antonio
AU - Pikija, Slaven
AU - Probstfield, Jeffrey
AU - Rost, Natalia S.
AU - Thrift, Amanda G.
AU - Vemmos, Konstantinos
AU - Kelly, Peter J.
PY - 2013/2
Y1 - 2013/2
N2 - 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.
AB - 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.
KW - cerebral infarction
KW - ischemia
KW - neuroprotective agents
KW - outcomes assessment
KW - stroke
KW - therapy
UR - http://www.scopus.com/inward/record.url?scp=84872929861&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872929861&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.112.668277
DO - 10.1161/STROKEAHA.112.668277
M3 - Review article
C2 - 23287777
AN - SCOPUS:84872929861
SN - 0039-2499
VL - 44
SP - 448
EP - 456
JO - Stroke
JF - Stroke
IS - 2
ER -