Xu Tao, Wang You, Yuan Jinxian, Chen Yangmei
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
CNS Drugs. 2021 Jul;35(7):717-726. doi: 10.1007/s40263-021-00829-6. Epub 2021 May 21.
Several real-world observational studies have investigated the association between statin treatment and outcomes of cardioembolic stroke. However, substantial uncertainties remain about this association.
We aimed to perform a systematic review and meta-analysis to determine the effect of statin treatment on the outcomes of cardioembolic stroke.
We systematically searched the PubMed and Embase databases for relevant clinical studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) with a random-effects model were used to assess the outcomes of interest.
A total of 18 observational studies published between 2009 and 2020 were included. No randomized clinical trial was found. Compared with non-statin treatment, statin treatment was not associated with a decreased risk of stroke recurrence in patients with cardioembolic stroke [PWCS] (RR, 0.93; 95% CI 0.82-1.06). However, compared with non-statin treatment, statin treatment was associated with a lower risk of all-cause death (RR, 0.59; 95% CI 0.49-0.73) and better functional outcomes (RR, 0.67; 95% CI 0.47-0.97) in PWCS. There was no significant association between statin treatment and major bleeding event risk in PWCS (RR, 0.35; 95% CI 0.06-2.16). Compared with non-statin treatment, statin treatment was not associated with a decreased risk of coronary atherosclerotic disease in PWCS (RR, 1.04; 95% CI 0.96-1.11).
Although the use of statins does not enhance the prevention of stroke recurrence in PWCS, statin treatment is associated with improved clinical outcomes in PWCS. Statins play a beneficial role in the treatment of cardioembolic stroke.
多项真实世界观察性研究探讨了他汀类药物治疗与心源性栓塞性卒中结局之间的关联。然而，这种关联仍存在诸多不确定性。
我们旨在进行一项系统评价和荟萃分析，以确定他汀类药物治疗对心源性栓塞性卒中结局的影响。
我们系统检索了PubMed和Embase数据库中的相关临床研究。采用随机效应模型合并相对风险（RR）和95%置信区间（CI）来评估感兴趣的结局。
共纳入2009年至2020年发表的18项观察性研究。未发现随机临床试验。与非他汀类药物治疗相比，他汀类药物治疗与心源性栓塞性卒中患者（PWCS）卒中复发风险降低无关（RR，0.93；95%CI 0.82 - 1.06）。然而，与非他汀类药物治疗相比，他汀类药物治疗与PWCS全因死亡风险较低（RR，0.59；95%CI 0.49 - 0.73）及更好的功能结局相关（RR，0.67；95%CI 0.47 - 0.97）。他汀类药物治疗与PWCS大出血事件风险之间无显著关联（RR，0.35；95%CI 0.06 - 2.16）。与非他汀类药物治疗相比，他汀类药物治疗与PWCS冠状动脉粥样硬化性疾病风险降低无关（RR，1.04；95%CI 0.96 - 1.11）。
尽管使用他汀类药物并不能增强对PWCS卒中复发的预防作用，但他汀类药物治疗与PWCS改善的临床结局相关。他汀类药物在心源性栓塞性卒中治疗中发挥有益作用。
