Stroke Center and Department of Neurology, National Taiwan University Hospital.
Department of Neurology, National Cheng Kung University Hospital.
J Atheroscler Thromb. 2021 Feb 1;28(2):146-156. doi: 10.5551/jat.55210. Epub 2020 May 15.
Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with ischemic stroke. One major metabolic derangement of CKD is dyslipidemia, which can be managed by statins. This study aimed to investigate whether the association of statins with post-stroke outcomes would be affected by renal function.
We evaluated the association of statin therapy at discharge with 3-month outcomes according to the estimated glomerular filtration rate (eGFR) of 50,092 patients with acute ischemic stroke from the Taiwan Stroke Registry from August 2006 to May 2016. The outcomes were mortality, functional outcome as modified Rankin Scale (mRS), and recurrent ischemic stroke at 3 months after index stroke.
Statin therapy at discharge was associated with lower risks of mortality (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.34 to 0.50) and unfavorable functional outcomes (mRS 3-5; aHR, 0.80; 95% CI, 0.76 to 0.84) in ischemic stroke patients. After stratification by eGFR, the lower risk of mortality associated with statins was limited to patients with an eGFR above 15 mL/min/1.73 m. Using statins at discharge was correlated with a lower risk of unfavorable functional outcomes in patients with an eGFR of 60-89 mL/min/1.73 m. Statin therapy in patients with an eGFR of 60-89 mL/min/1.73 m may be associated with a higher risk of recurrent ischemic stroke compared with nonusers (aHR, 1.29; 95% CI, 1.07 to 1.57).
In patients with acute ischemic stroke, the associations of statins with mortality and functional outcomes was dependent on eGFR.
慢性肾脏病（CKD）与缺血性脑卒中患者的不良预后相关。CKD 的一个主要代谢紊乱是血脂异常，可以通过他汀类药物来治疗。本研究旨在探讨他汀类药物与卒中后结局的相关性是否受肾功能的影响。
我们评估了 2006 年 8 月至 2016 年 5 月来自台湾脑卒中注册登记研究的 50092 例急性缺血性脑卒中患者出院时他汀类药物治疗与 3 个月结局的相关性，根据估算肾小球滤过率（eGFR）进行分层。结局为 3 个月时的死亡率、功能结局（改良 Rankin 量表，mRS）和复发性缺血性卒中。
出院时他汀类药物治疗与死亡率降低相关（校正后的危险比 [aHR]，0.41；95%置信区间 [CI]，0.34 至 0.50）和缺血性脑卒中患者不良功能结局（mRS 3-5；aHR，0.80；95%CI，0.76 至 0.84）。按 eGFR 分层后，他汀类药物降低死亡率的益处仅限于 eGFR 高于 15 mL/min/1.73 m 的患者。出院时使用他汀类药物与 eGFR 为 60-89 mL/min/1.73 m 的患者不良功能结局风险降低相关。与未使用者相比，eGFR 为 60-89 mL/min/1.73 m 的患者使用他汀类药物可能与复发性缺血性卒中风险增加相关（aHR，1.29；95%CI，1.07 至 1.57）。
在急性缺血性脑卒中患者中，他汀类药物与死亡率和功能结局的相关性取决于 eGFR。
