Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences.
Department of Neurology, Tokyo Women's Medical University School of Medicine.
J Atheroscler Thromb. 2020 Jun 1;27(6):524-533. doi: 10.5551/jat.51391. Epub 2019 Sep 25.
Posterior circulation stroke (PCS) has different clinical features and prognosis compared with anterior circulation stroke (ACS), and whether the effect of statin therapy on stroke prevention differs according to infarction location remains unclear. This post hoc analysis of the J-STARS study aimed to compare the usefulness of statin at different infarction locations (i.e., ACS and PCS).
In the J-STARS study, 1578 patients were randomly assigned to the pravastatin or control group. The subjects were divided into two subgroups (ACS and PCS groups) based on the arteries responsible for the infarction. Cox proportional hazards models were used to investigate whether the all stroke recurrence rate was different between the ACS and PCS groups.
The PCS group (n=499) had a significantly higher prevalence of diabetes than the ACS group (n=1022) (30.7% vs. 19.8%, P＜0.001). During the follow-up (4.9±1.4 years), the incidence of all stroke was significantly lower in the pravastatin group than in the control group among patients with PCS (adjusted hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.009); however, the stroke recurrence rates were not significantly different between both groups among patients with ACS (adjusted HR 1.32, 95% CI 0.93-1.88,P=0.123). A significant interaction between the ACS and PCS groups in terms of pravastatin effects was noted (P=0.003 for interaction).
Pravastatin significantly reduced the recurrence rate of all stroke among patients with PCS. Thus, the effect of statin on the recurrence of stroke may differ according to infarction location.
与前循环卒中（ACS）相比，后循环卒中（PCS）具有不同的临床特征和预后，他汀类药物治疗对卒中预防的效果是否因梗死部位而异尚不清楚。本 J-STARS 研究的事后分析旨在比较不同梗死部位（即 ACS 和 PCS）他汀类药物的作用。
在 J-STARS 研究中，1578 名患者被随机分配到普伐他汀或对照组。根据负责梗死的动脉，将受试者分为两个亚组（ACS 和 PCS 组）。使用 Cox 比例风险模型来研究 ACS 和 PCS 组之间全因卒中复发率是否不同。
PCS 组（n=499）的糖尿病患病率明显高于 ACS 组（n=1022）（30.7%比 19.8%，P＜0.001）。在随访期间（4.9±1.4 年），与对照组相比，普伐他汀组 PCS 患者的全因卒中发生率显著降低（校正风险比 [HR] 0.46，95%置信区间 [CI] 0.25-0.83，P=0.009）；然而，ACS 患者两组之间的卒中复发率无显著差异（校正 HR 1.32，95% CI 0.93-1.88，P=0.123）。ACS 和 PCS 两组之间在普伐他汀作用方面存在显著交互作用（P=0.003）。
普伐他汀显著降低了 PCS 患者全因卒中的复发率。因此，他汀类药物对卒中复发的影响可能因梗死部位而异。
