Lee Meng, Saver Jeffrey L, Wu Yi-Ling, Tang Sung-Chun, Lee Jiann-Der, Rao Neal M, Wang Hui-Hsuan, Jeng Jiann-Shing, Lee Tsong-Hai, Chen Pei-Chun, Ovbiagele Bruce
Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan
Stroke Center, Geffen School of Medicine, University of California, Los Angeles, CA.
J Am Heart Assoc. 2017 Aug 2;6(8):e005658. doi: 10.1161/JAHA.117.005658.
In-hospital discontinuation of statins has been linked to poorer early stroke outcomes, but the consequences of postdischarge discontinuation or dose reduction of statin treatment are unknown. The objective of this study was to explore the effects of statin discontinuation or statin dose reduction on recurrent stroke risk.
We conducted a nationwide cohort study using the data from the Taiwan National Health Insurance Research Database. Our source population comprised all patients who were prescribed a statin within 90 days of discharge after an ischemic stroke between 2001 and 2012. Patients were categorized into 3 groups: statin-discontinued, statin-reduced, and statin-maintained. Cox proportional hazard models were used to estimate the hazard ratios and 95%CIs of recurrent stroke during 1-year follow-up in the groups who discontinued statins or reduced statin dose compared with the group who maintained statins as the reference. Among the 45 151 ischemic stroke patients meeting criteria, during the day-90 to day-180 period, 7.0% were on reduced statin therapy, and 18.5% were not on any statin therapy. Compared with maintained-statin intensity therapy, discontinuation of statins was associated with an increased hazard of recurrent stroke (adjusted hazard ratio 1.42, 95%CI 1.28-1.57), whereas reduced-statin dose was not associated with an additional risk (adjusted hazard ratio 0.94, 95%CI 0.78-1.12). Propensity-matching analysis obtained similar results.
Discontinuation of statin therapy between 3 and 6 months after an index ischemic stroke was associated with a higher risk of recurrent stroke within 1 year after statin discontinuation.
住院期间停用他汀类药物与早期中风预后较差有关，但出院后停用他汀类药物治疗或降低剂量的后果尚不清楚。本研究的目的是探讨停用他汀类药物或降低他汀类药物剂量对复发性中风风险的影响。
我们使用台湾国民健康保险研究数据库的数据进行了一项全国性队列研究。我们的源人群包括2001年至2012年间缺血性中风出院后90天内开具他汀类药物处方的所有患者。患者分为3组：他汀类药物停用组、他汀类药物减量组和他汀类药物维持组。使用Cox比例风险模型估计停用他汀类药物或降低他汀类药物剂量组与以维持他汀类药物组为对照的1年随访期间复发性中风的风险比和95%置信区间。在45151名符合标准的缺血性中风患者中，在第90天至第180天期间，7.0%的患者接受了降低剂量的他汀类药物治疗，18.5%的患者未接受任何他汀类药物治疗。与维持他汀类药物强度治疗相比，停用他汀类药物与复发性中风风险增加相关（调整后风险比1.42，95%置信区间1.28-1.57），而降低他汀类药物剂量则与额外风险无关（调整后风险比0.94，95%置信区间0.78-1.12）。倾向匹配分析得到了类似的结果。
首次缺血性中风后3至6个月停用他汀类药物治疗与停用他汀类药物后1年内复发性中风风险较高相关。
