Department of Neurology First Hospital of Shanxi Medical University Taiyuan China.
Department of Neurology General Hospital of Tisco (Sixth Hospital of Shanxi Medical University) Taiyuan China.
J Am Heart Assoc. 2024 Jul 16;13(14):e035337. doi: 10.1161/JAHA.124.035337. Epub 2024 Jul 9.
Statins are widely used for treating patients with ischemic stroke at risk of secondary cerebrovascular events. It is unknown whether Asian populations benefit from more intensive statin-based therapy for stroke recurrence. Therefore, in the present study we evaluated the effectiveness and safety of high-dose and moderate-dose statins for patients who had experienced mild ischemic stroke during the acute period.
This multicenter prospective study included patients with mild ischemic stroke who presented within 72 hours of symptom onset. The outcomes of patients in the high-intensity and moderate-intensity statin treatment groups were compared, with the main efficacy outcome being stroke recurrence and the primary safety end point being intracranial hemorrhage. The propensity score matching method was employed to control for imbalances in baseline variables. Subgroup analyses were conducted to evaluate group differences. In total, the data of 2950 patients were analyzed at 3 months, and the data of 2764 patients were analyzed at 12 months due to loss to follow-up. According to the multivariable Cox analyses adjusted for potential confounders, stroke recurrence occurred similarly in the high-intensity statin and moderate-intensity statin groups (3 months: adjusted hazard ratio [HR], 1.12 [95% CI, 0.85-1.49]; =0.424; 12 months: adjusted HR, 1.08 [95% CI, 0.86-1.34]; =0.519). High-intensity statin therapy was associated with an increased risk of intracranial hemorrhage (3 months: adjusted HR, 1.81 [95% CI, 1.00-3.25]; =0.048; 12 months: adjusted HR, 1.86 [95% CI, 1.10-3.16]; =0.021). The results from the propensity score-matched analyses were consistent with those from the Cox proportional hazards analysis.
Compared with moderate-intensity statin therapy, high-dose statin therapy may not decrease the risk of mild, noncardiogenic ischemic stroke recurrence but may increase the risk of intracranial hemorrhage.
URL: www.chictr.org.cn/. Unique Identifier: ChiCTR1900025214.
他汀类药物广泛用于治疗有继发性脑血管事件风险的缺血性脑卒中患者。尚不清楚亚洲人群是否从更强化的他汀类药物治疗脑卒中复发中获益。因此，本研究评估了在急性发病期经历轻度缺血性脑卒中的患者中应用大剂量和中等剂量他汀类药物的有效性和安全性。
这是一项多中心前瞻性研究，纳入了发病 72 小时内的轻度缺血性脑卒中患者。比较高强度他汀治疗组和中强度他汀治疗组的患者结局，主要疗效终点为脑卒中复发，主要安全性终点为颅内出血。采用倾向评分匹配法来控制基线变量的不平衡。进行亚组分析以评估组间差异。共分析了 2950 例患者的 3 个月数据，由于失访，2764 例患者的 12 个月数据可用于分析。根据多变量 Cox 分析，校正潜在混杂因素后，高强度他汀组和中强度他汀组的脑卒中复发情况相似（3 个月：校正风险比 [HR]，1.12[95%CI，0.85-1.49]；=0.424；12 个月：校正 HR，1.08[95%CI，0.86-1.34]；=0.519）。高强度他汀治疗与颅内出血风险增加相关（3 个月：校正 HR，1.81[95%CI，1.00-3.25]；=0.048；12 个月：校正 HR，1.86[95%CI，1.10-3.16]；=0.021）。倾向评分匹配分析的结果与 Cox 比例风险分析的结果一致。
与中强度他汀治疗相比，大剂量他汀治疗可能不会降低非心源性轻度缺血性脑卒中复发的风险，但可能会增加颅内出血的风险。
