Gordon-Kundu Barbara, Peyravi Reza, Garg Anisha, Baker Anna, Salas Samantha, Levien Michael, Faridi Kamil F, de Havenon Adam, Krumholz Harlan M, Sheth Kevin N, Forman Rachel, Sharma Richa
Department of Neurology, Division of Cerebrovascular Diseases Hackensack Meridian School of Medicine Nutley NJ USA.
Department of Neurology, Center for Brain and Mind Health, Division of Vascular Neurology Yale School of Medicine New Haven CT USA.
J Am Heart Assoc. 2025 Jan 21;14(2):e033365. doi: 10.1161/JAHA.123.033365. Epub 2024 Dec 19.
Elevated low-density lipoprotein cholesterol is a risk factor for atherosclerotic cardiovascular disease, including acute ischemic stroke (AIS), due to large- and small-vessel disease. Cholesterol management guidelines recommend lipid-lowering therapy (LLT) to prevent atherosclerotic cardiovascular disease events. This study assessed use of LLT at the time of AIS according to guideline recommendations and determined the association of prestroke LLT use with stroke severity.
We conducted a retrospective study of patients hospitalized with AIS from 2015 to 2020 at a large academic comprehensive stroke center. Patients with AIS secondary to either small-vessel disease or large-artery atherosclerosis recorded in the institutional Get With The Guidelines-Stroke registry and with a prestroke indication for LLT were included. Using propensity score subclassification, adjusted logistic regression models were built to explore the associations between LLT use before AIS when indicated and presenting National Institutes of Health Stroke Scale score >4. There were 384 patients with AIS who met guideline-recommended criteria for prestroke LLT (median age 70 years, 57% men), of whom only 207 patients (54%) were prescribed LLT before AIS. Not being prescribed LLT when indicated was associated with a significantly higher likelihood of a presenting with National Institutes of Health Stroke Scale score >4, even when adjusted for specific stroke cause (odds ratio, 1.13 [95% CI, 1.03-1.20]; =0.006).
LLT is underused in patients who present with atherosclerosis-related AIS. Lack of prestroke LLT use was associated with more severe stroke symptoms upon presentation. These findings emphasize the need to prescribe LLT when indicated, because its use may mitigate poststroke disability.
低密度脂蛋白胆固醇升高是动脉粥样硬化性心血管疾病的危险因素，包括因大血管和小血管疾病导致的急性缺血性卒中（AIS）。胆固醇管理指南推荐使用降脂治疗（LLT）以预防动脉粥样硬化性心血管疾病事件。本研究根据指南建议评估了AIS发生时LLT的使用情况，并确定了卒中前使用LLT与卒中严重程度之间的关联。
我们对2015年至2020年在一家大型学术性综合卒中中心住院的AIS患者进行了一项回顾性研究。纳入机构“遵循卒中指南”登记册中记录的继发于小血管疾病或大动脉粥样硬化的AIS患者，且这些患者有卒中前LLT指征。使用倾向评分亚分类法构建调整后的逻辑回归模型，以探讨在有指征时AIS前使用LLT与美国国立卫生研究院卒中量表评分>4之间的关联。有384例AIS患者符合卒中前LLT的指南推荐标准（中位年龄70岁，57%为男性），其中只有207例患者（54%）在AIS前接受了LLT治疗。即使在根据特定卒中病因进行调整后，有指征时未接受LLT治疗与美国国立卫生研究院卒中量表评分>4的可能性显著更高相关（比值比，1.13[95%CI，1.03 - 1.20]；P = 0.006）。
在患有动脉粥样硬化相关AIS的患者中，LLT的使用不足。卒中前未使用LLT与就诊时更严重的卒中症状相关。这些发现强调了在有指征时开具LLT处方的必要性，因为其使用可能减轻卒中后残疾。
