Department of Emergency Neurology/Stroke Unit, National Neurologic Institute C, Mondino IRCCS, Pavia, Italy.
BMC Neurol. 2014 Mar 21;14:53. doi: 10.1186/1471-2377-14-53.
Statins, due to their well-established pleiotropic effects, have noteworthy benefits in stroke prevention. Despite this, a significant proportion of high-risk patients still do not receive the recommended therapeutic regimens, and many others discontinue treatment after being started on them. The causes of non-adherence to current guidelines are multifactorial, and depend on both physicians and patients. The aim of this study is to identify the factors influencing statin prescription at Stroke Unit (SU) discharge.
This study included 12,750 patients enrolled on the web-based Lombardia Stroke Registry (LRS) from July 2009 to April 2012 and discharged alive, with a diagnosis of ischemic stroke or transient ischemic attack (TIA) and without contra-indication to statin therapy. By logistic regression analysis and classification trees, we evaluated the impact of demographic data, risk factors, tPA treatment, in-hospital procedures and complications on statin prescription rate at discharge.
We observed a slight increase in statins prescription during the study period (from 39.1 to 43.9%). Lower age, lower stroke severity and prestroke disability, the presence of atherothrombotic/lacunar risk factors, a diagnosis of non-cardioembolic stroke, tPA treatment, the absence of in-hospital complications, with the sole exception of hypertensive fits and hyperglycemia, were the patient-related predictors of adherence to guidelines by physicians. Overall, dyslipidemia appears as the leading factor, while TOAST classification does not reach statistical significance.
In our region, Lombardia, adherence to guidelines in statin prescription at Stroke Unit discharge is very different from international goals. The presence of dyslipidemia remains the main factor influencing statin prescription, while the presence of well-defined atherosclerotic etiopathogenesis of stroke does not enhance statin prescription. Some uncertainties about the risk/benefit of statin therapy in stroke etiology subtypes (cardioembolism, other or undetermined causes) may partially justify the underuse of statin in ischemic stroke. The differences that exist between current international guidelines may prevent a more widespread use of statin and should be clarified in a consensus.
由于他汀类药物具有明确的多效性作用，因此在预防中风方面具有显著益处。尽管如此，仍有相当一部分高危患者未接受推荐的治疗方案，而许多其他患者在开始治疗后也停止了治疗。不遵守现行指南的原因是多方面的，取决于医生和患者。本研究旨在确定影响中风单元（SU）出院时他汀类药物处方的因素。
本研究纳入了 2009 年 7 月至 2012 年 4 月期间在基于网络的伦巴第中风登记处（LRS）登记的 12750 名患者，这些患者存活出院，诊断为缺血性中风或短暂性脑缺血发作（TIA），且无他汀类药物治疗禁忌。通过逻辑回归分析和分类树，我们评估了人口统计学数据、危险因素、tPA 治疗、住院期间的程序和并发症对出院时他汀类药物处方率的影响。
我们观察到研究期间他汀类药物的处方略有增加（从 39.1%增加到 43.9%）。较低的年龄、较低的中风严重程度和中风前残疾、存在动脉粥样硬化/腔隙性危险因素、非心源性脑卒中和 tPA 治疗、无住院期间并发症，除高血压发作和高血糖外，这些都是医生遵医嘱开具他汀类药物的患者相关预测因素。总的来说，血脂异常似乎是主要因素，而 TOAST 分类则没有达到统计学意义。
在我们的地区伦巴第，中风单元出院时他汀类药物的处方遵循指南的情况与国际目标相差甚远。血脂异常的存在仍然是影响他汀类药物处方的主要因素，而中风明确的动脉粥样硬化病因学并不增强他汀类药物的处方。在中风病因亚型（心源性栓塞、其他或原因不明）中，他汀类药物治疗的风险/获益存在一些不确定性，这可能部分解释了缺血性中风中他汀类药物使用不足的现象。当前国际指南之间的差异可能会阻止他汀类药物更广泛的使用，应该在共识中阐明。
