Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan.
Atherosclerosis. 2019 Sep;288:137-145. doi: 10.1016/j.atherosclerosis.2019.07.009. Epub 2019 Jul 11.
Intracerebral hemorrhage (ICH) has a higher mortality than ischemic stroke. Statin is beneficial for stroke, but high potency statin treatment has been associated with the risk of hemorrhagic stroke. The aim of this study was to assess the impact of initiating statin therapy after ICH on cardiovascular outcomes.
Dyslipidemic patients were retrieved from the ICH population from the National Health Insurance Research Database in Taiwan. We retrospectively compared patients prescribed with and without statin treatment after ICH. Outcomes of interest were mortality, myocardial infarction, ischemic stroke, and hemorrhagic stroke during 5 years of follow-up.
Of 17,980 adult patients with ICH and dyslipidemia, 8927 were eligible for analysis over the study period, including 1613 patients receiving statin therapy and 7314 patients not taking statins. After propensity score matching, the mean age was 61.2 ± 12.2 years in the statin group and 61.6 ± 13.0 years in the non-statin group. Hypertension was dominant, followed by diabetes mellitus, and the mean estimated NIHSS score was 12.9. The patients who received statin therapy were associated with lower risks of all-cause mortality (12.7% vs. 21.3%; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.45-0.65), cardiovascular death (4.0% vs. 7.1%; HR, 0.54; 95% CI, 0.39-0.75) and ICH (5.4% vs. 8.5%; HR, 0.62; 95% CI, 0.46-0.83) compared to those who did not receive statins.
Initiating statin therapy after ICH was associated with a decreased risk of recurrent ICH and mortality for dyslipidemia patients.
脑出血 (ICH) 的死亡率高于缺血性脑卒中。他汀类药物对脑卒中有益，但高强度他汀类药物治疗与出血性脑卒中的风险相关。本研究旨在评估 ICH 后开始他汀类药物治疗对心血管结局的影响。
从台湾全民健康保险研究数据库的 ICH 人群中检索出血脂异常患者。我们回顾性比较了 ICH 后接受和未接受他汀类药物治疗的患者。主要研究终点为 5 年随访期间的死亡率、心肌梗死、缺血性卒中和出血性卒中。
在 17980 名患有 ICH 和血脂异常的成年患者中，1613 名患者接受他汀类药物治疗，7314 名患者未接受他汀类药物治疗，共有 8927 名患者符合分析条件。在倾向评分匹配后，他汀组的平均年龄为 61.2±12.2 岁，非他汀组为 61.6±13.0 岁。高血压是最常见的合并症，其次是糖尿病，平均 NIHSS 评分估计为 12.9。接受他汀类药物治疗的患者发生全因死亡率（12.7%比 21.3%；风险比 [HR]，0.54；95%置信区间 [CI]，0.45-0.65）、心血管死亡率（4.0%比 7.1%；HR，0.54；95% CI，0.39-0.75）和 ICH（5.4%比 8.5%；HR，0.62；95% CI，0.46-0.83）的风险均低于未接受他汀类药物治疗的患者。
ICH 后开始他汀类药物治疗与血脂异常患者的复发性 ICH 和死亡率降低相关。
