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Statin therapy in acute cardioembolic stroke with no guidance-based indication.

Abstract：

OBJECTIVE:It is uncertain whether patients with cardioembolic stroke and without a guidance-based indication for statin therapy should be administered a statin for prevention of subsequent vascular events. This study was performed to determine whether the statin therapy is beneficial in preventing major vascular events in this population. METHODS:Using a prospective multicenter stroke registry database, we identified patients with acute cardioembolic stroke who were hospitalized between 2008 and 2015. Patients who had other established indications for statin therapy according to current guidelines were excluded. Major vascular event was defined as a composite of stroke recurrence, myocardial infarction, and vascular death. We performed frailty model analysis with the robust sandwich variance estimator using the stabilized inverse probability of treatment weighting method to estimate hazard ratios of statin therapy on outcomes. RESULTS:Of 6,124 patients with cardioembolic stroke, 2,888 (male 44.6%, mean age 75.3 years, 95% confidence interval [CI] 74.8-75.8) were eligible, and 1,863 (64.5%) were on statin therapy during hospitalization. After a median follow-up of 359 days, cumulative incidences of major vascular events were 9.3% in the statin users and 20.5% in the nonusers (p < 0.001 by log-rank test). The adjusted hazard ratios of statin therapy were 0.39 (95% CI 0.31-0.48) for major vascular events, 0.81 (95% CI 0.57-1.16) for stroke recurrence, 0.28 (95% CI 0.21-0.36) for vascular death, and 0.53 (95% CI 0.45-0.61) for all-cause death. CONCLUSION:Starting statin during the acute stage of ischemic stroke may reduce the risk of major vascular events, vascular death, and all-cause death in patients with cardioembolic stroke with no guidance-based indication for statin.

journal_name

Neurology

journal_title

Neurology

authors

Park HK,Lee JS,Hong KS,Cho YJ,Park JM,Kang K,Lee SJ,Kim JG,Cha JK,Kim DH,Nah HW,Han MK,Kim BJ,Park TH,Park SS,Lee KB,Lee J,Lee BC,Yu KH,Oh MS,Kim JT,Choi KH,Kim DE,Ryu WS,Choi JC,Kwon JH,Kim WJ,Shin

doi

10.1212/WNL.0000000000009397

subject

Has Abstract

pub_date

2020-05-12 00:00:00

pages

e1984-e1995

issue

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000009397

journal_volume

pub_type

杂志文章,多中心研究

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Statin therapy in acute cardioembolic stroke with no guidance-based indication.