Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain.
J Clin Pharm Ther. 2012 Aug;37(4):441-7. doi: 10.1111/j.1365-2710.2011.01318.x. Epub 2011 Nov 7.
The effect of a statin-based medical intervention on prevention of fatal and non-fatal stroke recurrence and the incidence of all-causes mortality have been explored previously in aging populations within the scope of clinical trials research. However, such evidence needs to be explored under conditions of routine clinical practice. The objective of this study was to determine whether statin therapy in patients with a first stroke episode reduces the incidence of 6-year recurrent fatal or non-fatal stroke and all-cause mortality in an aging Mediterranean population without known coronary heart disease followed in routine medical practice.
A retrospective study was carried out using records on death, hospitalizations owing to stroke and history of statin therapy included in the Badalona Serveis Assistencials (BSA) database. The cohort studied consisted of consecutive patients covered by the BSA health provider plan with a first-ever acute stroke episode during January 2003 until December 2008, for whom there was available information covering the 6-year follow-up period. Recurrence rate (RR) and incidence rate (IR) of fatal/non-fatal stroke and all-causes mortality were computed. Association with statin therapy was assessed by means of calculation of relative risk (RR) and hazard ratio (HR) using multivariate logistic regression and Cox proportional hazards models controlling for confounding covariates.
The cohort comprised a series of 601 consecutive patients [57% men, 75·9 (12·4) years old (88% >60 years)]. Of these, 32% received statins, which were associated with lower fatal/non-fatal recurrent stroke RR; 7% vs. 18% [adjusted RR=0·32 (CI: 0·16-0·61), P=0·001] and lower IR; 16·78 vs. 45·22 events/year-1000 subjects [adjusted HR=0·35 (0·19-0·64), P=0·001]. Similarly, observed all-causes mortality was lower in the cohort receiving statins; 11% vs. 16% [adjusted RR=0·29 (CI: 0·08-1·12), P=0·072], and also mortality rate; 26·09 vs. 36·25 deaths/year-1000 subjects [adjusted HR=0·23 (0·08-0·67), P=0·007].
Statin therapy in patients with first-ever acute stroke lowers the risk of 6-year stroke recurrence and improves survival in an aging Mediterranean cohort. These results add additional evidence in routine clinical practice to the observed effects of statins in clinical trials.
在临床试验研究范围内，先前已经探讨了他汀类药物为基础的医学干预对预防致命和非致命性中风复发以及全因死亡率的影响。然而，需要在常规临床实践条件下探索这种证据。本研究的目的是确定在常规医疗实践中，他汀类药物治疗是否会降低首次中风发作患者 6 年内复发的致命或非致命性中风和全因死亡率的发生率。
使用 Badalona Serveis Assistencials（BSA）数据库中包含的死亡记录、因中风住院记录和他汀类药物治疗史，进行了一项回顾性研究。所研究的队列由在 2003 年 1 月至 2008 年 12 月期间首次发生急性中风的连续患者组成，他们有 6 年随访期的可用信息。计算了致命/非致命性中风和全因死亡率的复发率（RR）和发病率（IR）。使用多变量逻辑回归和 Cox 比例风险模型评估他汀类药物治疗与风险比（RR）和风险比（HR）的相关性，同时控制混杂因素。
该队列包括一系列 601 名连续患者[57%为男性，75.9（12.4）岁（88%>60 岁）]。其中，32%接受了他汀类药物治疗，与较低的致命/非致命性复发性中风 RR 相关；7% vs. 18%[调整后的 RR=0.32（0.16-0.61），P=0.001]和较低的发病率；16.78 比 45.22 事件/年-1000 个受试者[调整后的 HR=0.35（0.19-0.64），P=0.001]。同样，接受他汀类药物治疗的患者的全因死亡率也较低；11% vs. 16%[调整后的 RR=0.29（0.08-1.12），P=0.072]，死亡率也较低；26.09 比 36.25 人/年-1000 个受试者[调整后的 HR=0.23（0.08-0.67），P=0.007]。
他汀类药物治疗首次急性中风患者可降低 6 年内中风复发的风险，并改善地中海老龄化队列的生存。这些结果在常规临床实践中为临床试验中观察到的他汀类药物的作用提供了额外的证据。
