From the Division of Research, Kaiser Permanente Northern California, Oakland, (A.C.F., C.C.); Department of Neuroscience (A.C.F., S.L.C., V.A.R.) and Department of Cardiology (X.R.), Kaiser Permanente, Redwood City, CA; Department of Neurology, Cornell University, New York, NY (H.K.); and Department of Neurology, University of Texas at Austin (S.C.J.).
Stroke. 2017 Jul;48(7):1788-1794. doi: 10.1161/STROKEAHA.117.017343. Epub 2017 Jun 8.
Outpatient statin use reduces the risk of recurrent ischemic stroke among patients with stroke of atherothrombotic cause. It is not known whether statins have similar effects in ischemic stroke caused by atrial fibrillation (AFib).
We studied outpatient statin adherence, measured by percentage of days covered, and the risk of recurrent ischemic stroke in patients with or without AFib in a 21-hospital integrated healthcare delivery system.
Among 6116 patients with ischemic stroke discharged on a statin over a 5-year period, 1446 (23.6%) had a diagnosis of AFib at discharge. The mean statin adherence rate (percentage of days covered) was 85, and higher levels of percentage of days covered correlated with greater degrees of low-density lipoprotein suppression. In multivariable survival models of recurrent ischemic stroke over 3 years, after controlling for age, sex, race/ethnicity, medical comorbidities, and hospital center, higher statin adherence predicted reduced stroke risk both in patients without AFib (hazard ratio, 0.78; 95% confidence interval, 0.63-0.97) and in patients with AFib (hazard ratio, 0.59; 95% confidence interval, 0.43-0.81). This association was robust to adjustment for the time in the therapeutic range for international normalized ratio among AFib subjects taking warfarin (hazard ratio, 0.61; 95% confidence interval, 0.41-0.89).
The relationship between statin adherence and reduced recurrent stroke risk is as strong among patients with AFib as it is among patients without AFib, suggesting that AFib status should not be a reason to exclude patients from secondary stroke prevention with a statin.
门诊使用他汀类药物可降低动脉粥样硬化性血栓性卒中患者的复发性缺血性卒中风险。尚不清楚他汀类药物在由心房颤动（房颤）引起的缺血性卒中患者中是否具有类似的效果。
我们在一个由 21 家医院组成的综合性医疗服务系统中，研究了门诊他汀类药物的使用情况，通过覆盖率来衡量，以及在有无房颤的患者中，复发性缺血性卒中的风险。
在 5 年内出院时服用他汀类药物的 6116 例缺血性卒中患者中，有 1446 例（23.6%）在出院时诊断为房颤。他汀类药物的平均覆盖率（覆盖率百分比）为 85%，较高的覆盖率百分比与更大程度的低密度脂蛋白抑制相关。在 3 年内复发性缺血性卒中的多变量生存模型中，在控制年龄、性别、种族/民族、合并症和医院中心后，较高的他汀类药物使用率预测无房颤患者的卒中风险降低（风险比，0.78；95%置信区间，0.63-0.97）和房颤患者（风险比，0.59；95%置信区间，0.43-0.81）。这种关联在调整接受华法林治疗的房颤患者的国际标准化比值治疗范围内的时间后仍然稳健（风险比，0.61；95%置信区间，0.41-0.89）。
他汀类药物使用率与降低复发性卒中风险之间的关系在房颤患者中与无房颤患者一样强，这表明房颤状态不应成为将患者排除在他汀类药物二级卒中预防之外的理由。
