Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University & Aarhus University Hospital, Aarhus, Denmark.
Eur Stroke J. 2023 Dec;8(4):1041-1052. doi: 10.1177/23969873231193288. Epub 2023 Aug 9.
Guidelines recommend high-intensity statin treatment after ischemic stroke, but evidence is sparse on the effectiveness and safety of different statin treatment intensities. We examined effectiveness and safety outcomes among patients initiating high-intensity versus moderate-intensity statins after ischemic stroke.
In this population-based new-user active-comparator cohort study, we used the Danish Stroke Registry, covering all Danish hospitals, to identify patients with a first-time ischemic stroke during 2012-2021. Using multiple Danish registries, patients who redeemed a statin prescription within 21 days after stroke admission were classified as high-intensity statin initiators or moderate-intensity statin initiators. Propensity score inverse probability of treatment weighting was used to balance patient characteristics. We used competing risk methods to compute 5 year risk differences (RDs) and Cox proportional hazards regression to compute 5 year hazard ratios (HRs) of stroke recurrence, myocardial infarction, heart failure, venous thromboembolism, and all-cause mortality (effectiveness outcomes) and diabetes, liver disease, and kidney disease (safety outcomes).
High-intensity ( = 13,032) and moderate-intensity ( = 14,355) statin initiators were identified. Risks of most examined effectiveness outcomes were comparable between statin intensities. There was no clear association between statin intensity and stroke recurrence (RD: 0.8% [95% CI: 0.1, 1.4], HR: 1.08 [95% CI: 0.96, 1.22]). All-cause mortality was slightly reduced among high-intensity statin initiators (RD: -1.1% [95% CI: -0.1, -2.1], HR: 0.93 [95% CI: 0.85, 1.01]. Risks of most safety outcomes were comparable between statin intensities, but high-intensity statin use was associated with an increased risk of diabetes (RD: 1.2% [95% CI: 0.4, 1.9], HR: 1.10 [95% CI: 1.00, 1.21]).
Compared with initiation of moderate-intensity statins, initiation of high-intensity statins after ischemic stroke was associated with similar risks of most effectiveness and safety outcomes. However, mortality risk was reduced, and diabetes risk was increased.
指南建议在发生缺血性卒中后进行高强度他汀类药物治疗，但关于不同他汀类药物治疗强度的有效性和安全性证据有限。我们研究了缺血性卒中后开始高强度与中强度他汀类药物治疗的患者的有效性和安全性结局。
在这项基于人群的新使用者活性对照队列研究中，我们使用丹麦卒中登记处覆盖所有丹麦医院的数据，确定了 2012 年至 2021 年期间首次发生缺血性卒中的患者。通过多个丹麦登记处，在卒中入院后 21 天内开具他汀类药物处方的患者被归类为高强度他汀类药物起始者或中强度他汀类药物起始者。采用倾向评分逆概率治疗加权法平衡患者特征。我们使用竞争风险方法计算 5 年风险差异（RD），并使用 Cox 比例风险回归计算卒中复发、心肌梗死、心力衰竭、静脉血栓栓塞和全因死亡率（有效性结局）以及糖尿病、肝病和肾病（安全性结局）的 5 年危险比（HR）。
确定了高强度（ = 13032）和中强度（ = 14355）他汀类药物起始者。大多数研究的有效性结局风险在他汀类药物强度之间相当。他汀类药物强度与卒中复发之间没有明确的关联（RD：0.8%[95%CI：0.1，1.4]；HR：1.08[95%CI：0.96，1.22]）。高强度他汀类药物起始者的全因死亡率略有降低（RD：-1.1%[95%CI：-0.1，-2.1]；HR：0.93[95%CI：0.85，1.01]）。大多数安全性结局风险在他汀类药物强度之间相当，但高强度他汀类药物使用与糖尿病风险增加相关（RD：1.2%[95%CI：0.4，1.9]；HR：1.10[95%CI：1.00，1.21]）。
与开始中强度他汀类药物治疗相比，缺血性卒中后开始高强度他汀类药物治疗与大多数有效性和安全性结局的风险相当。然而，死亡率风险降低，糖尿病风险增加。
