缺乏他汀类药物治疗与缺血性脑卒中结局：一项基于人群的研究。
Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study.
机构信息
Neurocenter, Department of Neurology, Turku University Hospital and University of Turku, Finland (J.Å., J.O.R.).
Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Finland (A.T.).
出版信息
Stroke. 2023 Mar;54(3):781-790. doi: 10.1161/STROKEAHA.122.040536. Epub 2023 Feb 7.
BACKGROUND
Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes.
METHODS
IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were combined from national registries on hospital admissions, mortality, cancer diagnoses, prescription medication purchases, and permissions for special reimbursements for medications. Usage of prescription medication was defined as drug purchase within 90 days after hospital discharge. Ongoing statin use during follow-up was analyzed in 90-day intervals. Differences in baseline features, comorbidities, other medications, and recanalization therapies were balanced with inverse probability of treatment weighting. Median follow-up was 5.7 years.
RESULTS
Statin therapy was not used by 27.1% of patients within 90 days after IS discharge, with women and older patients using statins less frequently. The average proportion of patients without ongoing statin during the 12-year follow-up was 36.0%. Patients without early statins had higher all-cause mortality at 1 year (7.5% versus 4.4% in patients who did use statins; hazard ratio [HR], 1.74 [CI, 1.61-1.87]) and 12 years (56.8% versus 48.6%; HR, 1.37 [CI, 1.33-1.41]). Cumulative incidence of major adverse cerebrovascular or cardiovascular event was higher at 1 year (subdistribution HR, 1.36 [CI, 1.29-1.43]) and 12 years (subdistribution HR, 1.21 [CI, 1.18-1.25]) without early statin use. Cardiovascular death, recurrent IS, and myocardial infarction were more frequent without early statin use. Early statin use was not associated with hemorrhagic stroke during follow-up. Lack of ongoing statin during follow-up was associated with risk of death in time-dependent analysis (adjusted HR, 3.03 [CI, 2.96-3.23]).
CONCLUSIONS
Lack of statin treatment after IS is associated with adverse long-term outcomes. Measures to further improve timely statin use after IS are needed.
背景
他汀类药物治疗可有效预防缺血性卒中（IS）后的不良血管事件。然而，许多 IS 患者未能使用他汀类药物。我们研究了 IS 后不使用他汀类药物对不良结局的影响。
方法
回顾性研究了 20 家芬兰医院收治的 59588 名 IS 患者。研究数据来自于国家住院、死亡率、癌症诊断、处方药物购买和药物特殊报销许可登记处。使用处方药物定义为出院后 90 天内购买药物。使用他汀类药物的情况通过 90 天间隔的随访进行分析。通过逆概率治疗加权法平衡了基线特征、合并症、其他药物和再通治疗之间的差异。中位随访时间为 5.7 年。
结果
IS 出院后 90 天内，27.1%的患者未使用他汀类药物治疗，女性和老年患者使用他汀类药物的频率较低。在 12 年的随访期间，无持续使用他汀类药物的患者平均比例为 36.0%。无早期他汀类药物治疗的患者在 1 年（未使用他汀类药物治疗的患者为 7.5%，使用他汀类药物治疗的患者为 4.4%；危险比[HR]，1.74[95%CI，1.61-1.87]）和 12 年（未使用他汀类药物治疗的患者为 56.8%，使用他汀类药物治疗的患者为 48.6%；HR，1.37[95%CI，1.33-1.41]）的全因死亡率均较高。1 年（亚分布 HR，1.36[95%CI，1.29-1.43]）和 12 年（亚分布 HR，1.21[95%CI，1.18-1.25]）时主要不良脑血管或心血管事件的累积发生率较高，无早期他汀类药物治疗。无早期他汀类药物治疗时，心血管死亡、IS 再发和心肌梗死更为常见。随访期间无持续使用他汀类药物与出血性卒中无关。在时间依赖性分析中，无持续使用他汀类药物与死亡风险相关（调整后的 HR，3.03[95%CI，2.96-3.23]）。
结论
IS 后他汀类药物治疗的缺失与长期不良结局相关。需要采取进一步措施，以改善 IS 后及时使用他汀类药物的情况。
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