缺血性卒中和短暂性脑缺血发作后他汀类药物治疗的模式及预测因素：来自LIPYDS多中心研究的见解
Patterns and predictors of statin therapy after ischemic stroke and TIA: insights from the LIPYDS multicenter study.
作者信息
Cascio Rizzo Angelo, Schwarz Ghil, Paolucci Matteo, Cavallini Anna, Mazzacane Federico, Candelaresi Paolo, De Mase Antonio, Marcheselli Simona, Straffi Laura, Poretto Valentina, Giometto Bruno, Diomedi Marina, Bagnato Maria Rosaria, Zedde Marialuisa, Grisendi Ilaria, Petruzzellis Marco, Galotto Debora, Morotti Andrea, Padovani Alessandro, Bonaffini Novella, Cupini Letizia Maria, Caso Valeria, Bossi Francesco, Fanciulli Cristiano, Viola Maria Maddalena, Persico Alessandra, Spina Emanuele, Falcou Anne, Pantoni Leonardo, Mele Francesco, Silvestrini Mauro, Viticchi Giovanna, Pilato Fabio, Cappellari Manuel, Anticoli Sabrina, La Spina Paolo, Sessa Maria, Toni Danilo, Zini Andrea, Agostoni Elio Clemente
机构信息
Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, 20162, Italy.
Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore, Bologna, Italy.
出版信息
Neurol Sci. 2025 May;46(5):2183-2194. doi: 10.1007/s10072-024-07969-9. Epub 2025 Jan 13.
BACKGROUND
Patients with ischemic stroke (IS) or TIA face an elevated cardiovascular risk, warranting intensive lipid-lowering therapy. Despite recommendations, adherence to guidelines is suboptimal, leading to frequent undertreatment. This study aims to evaluate the statin use after IS and TIA.
METHODS
LIPYDS is a multicenter, observational, retrospective study including ≥ 18-year-old patients discharged after IS/TIA from 19 Italian centers in 2021. Multivariable logistic regression analysis was used to determine (1) the association between statin prescription (Any-statin versus No-statin), type (High-Intensity-statin versus Other-statin [Moderate/Low-Intensity]) with stroke etiology (TOAST), (2) clinical variables independently associated with statin prescription in the entire cohort and within TOAST categories.
RESULTS
We included 3,740 patients (median age 75 [IQR 64-82]; median LDL-C 104 [IQR 79-131]). At discharge, 1,971 (52.7%) received a High-intensity-statin, 800 (21.4%) Other-statin, 969 (25.9%) No-statin therapy. Among patients not on statin therapy before the event (N = 2686 [71.8%]), 50.1% initiated High-intensity-statin (78.2% of those with Large-Artery-Atherosclerosis, 60.8% Small-Vessel-Disease, 34.7% Cardioembolic, 47.4% Undetermined etiology); in 33% the decision to abstain from initiating statin therapy persisted. Large-Artery-Atherosclerosis showed the strongest association with Any-statin (aOR 3.07 [95%CI 2.39-3.95], p < 0.001) and High-intensity-statin (aOR 4.51 [95%CI 3.39-6.00], p < 0.001), while Cardioembolic stroke showed an inverse association (respectively, aOR 0.36 [95%CI 0.31-0.43], p < 0.001 and aOR 0.52 [95%CI 0.44-0.62], p < 0.001). Stepwise regression highlighted LDL-C and previous statin therapy as consistent predictors of statin at discharge. Older patients and women were less likely to be on a high-intensity formulation.
CONCLUSION
Statins, especially at high-intensity, are under-prescribed after IS and TIA, with older patients, women and those with non-atherosclerotic strokes being the most affected.
背景
缺血性中风（IS）或短暂性脑缺血发作（TIA）患者面临更高的心血管疾病风险，因此需要强化降脂治疗。尽管有相关建议，但指南的依从性仍不理想，导致治疗不足的情况频繁发生。本研究旨在评估IS和TIA后他汀类药物的使用情况。
方法
LIPYDS是一项多中心、观察性、回顾性研究，纳入了2021年从意大利19个中心出院的年龄≥18岁的IS/TIA患者。采用多变量逻辑回归分析来确定：（1）他汀类药物处方（使用任何他汀类药物与未使用他汀类药物）、类型（高强度他汀类药物与其他他汀类药物[中/低强度]）与中风病因（TOAST）之间的关联；（2）整个队列以及TOAST类别中与他汀类药物处方独立相关的临床变量。
结果
我们纳入了3740例患者（中位年龄75岁[四分位间距64 - 82岁]；中位低密度脂蛋白胆固醇104[四分位间距79 - 131]）。出院时，1971例（52.7%）接受高强度他汀类药物治疗，800例（21.4%）接受其他他汀类药物治疗，969例（25.9%）未接受他汀类药物治疗。在事件发生前未接受他汀类药物治疗的患者中（N = 2686例[71.8%]），50.1%开始使用高强度他汀类药物（大动脉粥样硬化患者中78.2%，小血管疾病患者中60.8%，心源性栓塞患者中34.7%，病因不明患者中47.4%）；33%的患者维持不启动他汀类药物治疗的决定。大动脉粥样硬化与使用任何他汀类药物（调整后比值比3.07[95%置信区间2.39 - 3.95]，p < 0.001）和高强度他汀类药物（调整后比值比4.51[95%置信区间3.39 - 6.00]，p < 0.001）的关联最强，而心源性栓塞性中风则呈负相关（分别为调整后比值比0.36[95%置信区间0.31 - 0.43]，p < 0.001和调整后比值比0.52[95%置信区间0.44 - 0.62]，p < 0.001）。逐步回归分析表明，低密度脂蛋白胆固醇和既往他汀类药物治疗是出院时他汀类药物使用的一致预测因素。老年患者和女性使用高强度制剂的可能性较小。
结论
IS和TIA后他汀类药物，尤其是高强度他汀类药物的处方不足，老年患者、女性和非动脉粥样硬化性中风患者受影响最大。
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