他汀类药物强度和依从性对急性缺血性脑卒中后长期预后的影响。

Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke.

机构信息

From the Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea (J.K.); and Department of Neurology (J.K., J.H.H.), Biostatistics Collaboration Unit (H.S.L.), and Department of Preventive Medicine (C.M.N.), Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Stroke. 2017 Oct;48(10):2723-2730. doi: 10.1161/STROKEAHA.117.018140. Epub 2017 Sep 15.

DOI:10.1161/STROKEAHA.117.018140

PMID:28916672

Abstract

BACKGROUND AND PURPOSE

Statin is an established treatment for secondary prevention after ischemic stroke. However, the effects of statin intensity and adherence on the long-term prognosis after acute stroke are not well known.

METHODS

This retrospective cohort study using a nationwide health insurance claim data in South Korea included patients admitted with acute ischemic stroke between 2002 and 2012. Statin adherence and intensity were determined from the prescription data for a period of 1 year after the index stroke. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. We performed multivariate Cox proportional regression analyses.

RESULTS

We included 8001 patients with acute ischemic stroke. During the mean follow-up period of 4.69±2.72 years, 2284 patients developed a primary outcome. Compared with patients with no statin, adjusted hazard ratios (95% confidence interval) were 0.74 (0.64-0.84) for good adherence, 0.93 (0.79-1.09) for intermediate adherence, and 1.07 (0.95-1.20) for poor adherence to statin. Among the 1712 patients with good adherence, risk of adverse events was lower in patients with high-intensity statin (adjusted hazard ratio [95% confidence interval], 0.48 [0.24-0.96]) compared with those with low-intensity statin. Neither good adherence nor high intensity of statin was associated with an increased risk of hemorrhagic stroke.

CONCLUSIONS

After acute ischemic stroke, high-intensity statin therapy with good adherence was significantly associated with a lower risk of adverse events.

摘要

背景与目的

他汀类药物是缺血性中风后二级预防的标准治疗方法。然而，他汀类药物强度和依从性对急性中风后长期预后的影响尚不清楚。

方法

本回顾性队列研究使用了韩国全国性医疗保险索赔数据，纳入了 2002 年至 2012 年期间因急性缺血性中风住院的患者。他汀类药物的依从性和强度是根据索引性中风后 1 年内的处方数据确定的。主要结局是复发性中风、心肌梗死和全因死亡率的复合事件。我们进行了多变量 Cox 比例风险回归分析。

结果

我们纳入了 8001 例急性缺血性中风患者。在平均 4.69±2.72 年的随访期间，2284 例患者发生了主要结局。与未服用他汀类药物的患者相比，良好依从组的调整后风险比（95%置信区间）为 0.74（0.64-0.84），中等依从组为 0.93（0.79-1.09），而低依从组为 1.07（0.95-1.20）。在 1712 例依从性良好的患者中，高强度他汀类药物治疗（调整后风险比[95%置信区间]，0.48[0.24-0.96]）与低强度他汀类药物治疗相比，不良事件的风险较低。良好的依从性和高强度的他汀类药物均与出血性中风风险的增加无关。