Stroke Center and Department of Neurology, Ronald Reagan-UCLA Medical Center, Los Angeles, Calif, USA.
Stroke. 2010 Jul;41(7):1508-13. doi: 10.1161/STROKEAHA.109.573618. Epub 2010 May 27.
The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed statins reduce vascular risk among patients with atherosclerotic stroke or transient ischemic attack. In this study, we assessed recent nationwide trends in discharge statin treatment after acute stroke and the influence of SPARCL on clinical practice.
Using data from eligible patients with stroke and transient ischemic attack admitted to Get With The Guidelines-Stroke (GWTG-Stroke) -participating hospitals between January 1, 2005, and December 31, 2007, we assessed discharge statin use over time and in relation to dissemination of the SPARCL results.
Among 173,284 patients with ischemic stroke and transient ischemic attack, overall discharge statin treatment was 83.5%. Discharge statin prescription climbed steadily but modestly over the 2-year study period from 75.7% to 84.8% (P<0.001) with a nonsignificant increase during SPARCL reporting but a return to prior levels thereafter. Factors associated with lower discharge statin use in patients without contraindications included female sex and South region.
Discharge statin prescription among hospitalized patients with stroke increased over time, but 1 in 5 patients still leaves the hospital without treatment. Primary drivers of increased use were secular trends and individual/hospital site characteristics.
降脂积极减少胆固醇水平预防中风（SPARCL）试验表明，他汀类药物可降低动脉粥样硬化性卒中和短暂性脑缺血发作患者的血管风险。本研究评估了急性脑卒中后出院时使用他汀类药物的近期全国趋势，以及 SPARCL 对临床实践的影响。
使用 2005 年 1 月 1 日至 2007 年 12 月 31 日期间符合条件的中风和短暂性脑缺血发作患者的 GWTG-Stroke 数据，我们评估了随着时间的推移和与 SPARCL 结果传播相关的出院时使用他汀类药物的情况。
在 173284 例缺血性卒中和短暂性脑缺血发作患者中，出院时他汀类药物治疗的总体比例为 83.5%。在 2 年的研究期间，出院时他汀类药物的处方稳步但适度增加，从 75.7%增加到 84.8%（P<0.001），在 SPARCL 报告期间没有显著增加，但此后又恢复到之前的水平。在没有禁忌症的患者中，导致出院时他汀类药物使用率较低的因素包括女性和南部地区。
住院脑卒中患者出院时他汀类药物的使用有所增加，但仍有 1/5 的患者出院时未接受治疗。使用率增加的主要驱动因素是时间趋势和个人/医院地点特征。
