Kim Joon-Tae, Lee Ji Sung, Kim Hyunsoo, Kim Beom Joon, Kang Jihoon, Lee Keon-Joo, Park Jong-Moo, Kang Kyusik, Lee Soo Joo, Kim Jae Guk, Cha Jae-Kwan, Kim Dae-Hyun, Park Tai Hwan, Lee Kyungbok, Lee Jun, Hong Keun-Sik, Cho Yong-Jin, Park Hong-Kyun, Lee Byung-Chul, Yu Kyung-Ho, Oh Mi Sun, Kim Dong-Eog, Choi Jay Chol, Kwon Jee-Hyun, Kim Wook-Joo, Shin Dong-Ick, Yum Kyu Sun, Sohn Sung Il, Hong Jeong-Ho, Lee Sang-Hwa, Park Man-Seok, Ryu Wi-Sun, Park Kwang-Yeol, Lee Juneyoung, Saver Jeffrey L, Bae Hee-Joon
Department of Neurology Chonnam National University Hospital, Chonnam National University Medical School Gwangju Korea.
Clinical Research Center Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine Seoul Korea.
J Am Heart Assoc. 2025 Feb 4;14(3):e038080. doi: 10.1161/JAHA.124.038080. Epub 2025 Feb 3.
Research specifically addressing the efficacy of rosuvastatin versus atorvastatin in patients with ischemic stroke is insufficient. Using a large stroke registry, we investigated whether 2 commonly used statins, rosuvastatin and atorvastatin, differ in their effectiveness in reducing the risk of vascular events in patients with acute ischemic stroke.
We analyzed data from a nationwide stroke registry in South Korea between January 2011 and April 2022. Patients with acute ischemic stroke within 7 days of onset who were prescribed either atorvastatin or rosuvastatin at discharge were included. The primary outcome was a composite of recurrent stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality within 1 year.
A total of 43 512 patients (age, 69.2±12.5 years; male, 59.8%) were analyzed in this study. Atorvastatin was used in 84.8% (n=36 903), and rosuvastatin was used in 15.2% (n=6609). The 1-year cumulative event rate of the composite of recurrent stroke, myocardial infarction, and all-cause mortality was significantly lower in the rosuvastatin group than in the atorvastatin group (9.7% [95% CI, 9.0-10.5] versus 10.7% [95% CI, 10.4-11.0]; =0.049). Cox proportional hazards analysis revealed that rosuvastatin, compared with atorvastatin, was significantly associated with less risk of 1-year composite of recurrent stroke, myocardial infarction, and all-cause mortality, with an absolute risk reduction of 1% [95% CI, -1.8 to -0.2] and a relative risk reduction of 11% (hazard ratio, 0.89 [95% CI, 0.82-0.97]). However, there were discrepancies in the statistical significance of the results between the propensity score matching and stabilized inverse probability of treatment weighting analysis.
The results of this analysis of a large cohort of patients with ischemic stroke suggested that, compared with atorvastatin, rosuvastatin was significantly associated with a reduced risk of a 1-year composite of recurrent stroke, myocardial infarction, and all-cause mortality in patients with acute ischemic stroke. However, in real clinical practice, rosuvastatin is used less than one-fifth as frequently as atorvastatin in patients with acute ischemic stroke. This study serves as a hypothesis-generating function.
专门针对瑞舒伐他汀与阿托伐他汀在缺血性中风患者中的疗效的研究并不充分。我们利用一个大型中风登记数据库，调查了两种常用他汀类药物瑞舒伐他汀和阿托伐他汀在降低急性缺血性中风患者血管事件风险方面的有效性是否存在差异。
我们分析了2011年1月至2022年4月期间韩国全国性中风登记数据库中的数据。纳入了发病7天内发生急性缺血性中风且出院时开具阿托伐他汀或瑞舒伐他汀处方的患者。主要结局是1年内复发性中风（出血性或缺血性）、心肌梗死和全因死亡率的复合结局。
本研究共分析了43512例患者（年龄69.2±12.5岁；男性占59.8%）。84.8%（n = 36903）的患者使用阿托伐他汀，15.2%（n = 6609）的患者使用瑞舒伐他汀。瑞舒伐他汀组复发性中风、心肌梗死和全因死亡率复合结局的1年累积事件发生率显著低于阿托伐他汀组（9.7% [95% CI，9.0 - 10.5] 对10.7% [95% CI，10.4 - 11.0]；P = 0.049）。Cox比例风险分析显示，与阿托伐他汀相比，瑞舒伐他汀与1年内复发性中风、心肌梗死和全因死亡率复合结局的风险显著降低相关，绝对风险降低1% [95% CI，-1.8至-0.2]，相对风险降低11%（风险比，0.89 [95% CI，0.82 - 0.97]）。然而，倾向评分匹配和稳定逆概率处理加权分析结果的统计学显著性存在差异。
这项对大量缺血性中风患者队列的分析结果表明，与阿托伐他汀相比，瑞舒伐他汀与急性缺血性中风患者1年内复发性中风、心肌梗死和全因死亡率复合结局风险的降低显著相关。然而，在实际临床实践中，急性缺血性中风患者使用瑞舒伐他汀的频率不到阿托伐他汀的五分之一。本研究起到了产生假设的作用。
