King's College London, School of Population Health and Environmental Sciences, London, United Kingdom,
King's College London, School of Population Health and Environmental Sciences, London, United Kingdom.
Cerebrovasc Dis. 2019;47(5-6):260-267. doi: 10.1159/000501543. Epub 2019 Jul 16.
The benefit of statins on stroke incidence is well known. However, data on the relationship between pre- and post-stroke statin use, recurrence, and survival outcomes are limited. We aim to investigate the short- and long-term relationships between statin prescription, stroke recurrence, and survival in patients with first-ever ischemic stroke.
Data were collected from the population-based South London Stroke Register for the years 1995-2015. Patients were assessed at the time of first ever stroke, 3 months, and annually thereafter. Data on vascular risk factors, treatments prescribed, sociodemographic characteristics, stroke subtype, survival, and stroke recurrence were collected. Cox proportional hazard analyses were used to assess the relationship of statin prescriptions pre- and post-stroke on stroke severity, long-term recurrence and survival.
Patients prescribed statins both pre- and post-stroke showed a 24% reduction in mortality (adjusted Hazard Ratio [aHR] 0.76, 0.60-0.97), those who were prescribed statins pre-stroke and then stopped post-stroke showed greater risk of mortality (aHR 1.85, 1.10-3.12) and stroke recurrence (aHR 3.25, 1.35-7.84) compared to those that were not prescribed statins at any time. No associations were observed between pre-stroke statin and severity of the initial stroke overall, though a protective effect against moderate/severe stroke (Glasgow Coma Scale ≤12) was observed in those aged 75+ years (aOR 0.70, 0.52-0.95).
Statins play a significant role in improving the survival rates after a stroke. Adherence to the National Guidelines that promote statin treatment, primary and secondary prevention of stroke should be monitored and a focus for quality improvement programs.
他汀类药物对中风发病率的益处众所周知。然而，关于中风前和中风后使用他汀类药物与复发和生存结果之间关系的数据有限。我们旨在研究首次缺血性中风患者中他汀类药物处方、中风复发和生存之间的短期和长期关系。
数据来自于 1995-2015 年基于人群的南伦敦中风登记处。患者在首次中风时、3 个月和此后每年进行评估。收集了血管危险因素、开处方的治疗方法、社会人口特征、中风类型、生存和中风复发的数据。使用 Cox 比例风险分析评估中风前和中风后开具他汀类药物处方与中风严重程度、长期复发和生存之间的关系。
中风前和中风后都开他汀类药物处方的患者死亡率降低了 24%（调整后的危险比[aHR]0.76，0.60-0.97），中风前开他汀类药物处方但中风后停止服用的患者死亡率（aHR 1.85，1.10-3.12）和中风复发（aHR 3.25，1.35-7.84）的风险更高与任何时候都未服用他汀类药物的患者相比。总体而言，中风前服用他汀类药物与初始中风的严重程度之间没有关联，但在 75 岁以上的患者中观察到他汀类药物对中度/重度中风（格拉斯哥昏迷量表≤12）有保护作用（aOR 0.70，0.52-0.95）。
他汀类药物在提高中风后生存率方面发挥着重要作用。应监测并关注国家指南促进他汀类药物治疗、中风的一级和二级预防的依从性，作为质量改进计划的重点。
