Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials.

Hdl Handle:
http://hdl.handle.net/10147/264761
Title:
Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials.
Authors:
Ní Chróinín, Danielle; Asplund, Kjell; Asberg, Signild; Callaly, Elizabeth; Cuadrado-Godia, Elisa; Díez-Tejedor, Exuperio; Di Napoli, Mario; Engelter, Stefan T; Furie, Karen L; Giannopoulos, Sotirios; Gotto, Antonio M; Hannon, Niamh; Jonsson, Fredrik; Kapral, Moira K; Martí-Fàbregas, Joan; Martínez-Sánchez, Patricia; Milionis, Haralampos J; Montaner, Joan; Muscari, Antonio; Pikija, Slaven; Probstfield, Jeffrey; Rost, Natalia S; Thrift, Amanda G; Vemmos, Konstantinos; Kelly, Peter J
Affiliation:
From the Neurovascular Unit for Applied Translational Research and Therapeutics, Mater University Hospital/Dublin Academic Medical Centre, University College Dublin, Ireland.
Citation:
Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials. 2013: Stroke
Journal:
Stroke; a journal of cerebral circulation
Issue Date:
3-Jan-2013
URI:
http://hdl.handle.net/10147/264761
DOI:
10.1161/STROKEAHA.112.668277
PubMed ID:
23287777
Abstract:
Background-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS: The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS: The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSIONS: In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.
Item Type:
Article
Language:
en
ISSN:
1524-4628

Full metadata record

DC FieldValue Language
dc.contributor.authorNí Chróinín, Danielleen_GB
dc.contributor.authorAsplund, Kjellen_GB
dc.contributor.authorAsberg, Signilden_GB
dc.contributor.authorCallaly, Elizabethen_GB
dc.contributor.authorCuadrado-Godia, Elisaen_GB
dc.contributor.authorDíez-Tejedor, Exuperioen_GB
dc.contributor.authorDi Napoli, Marioen_GB
dc.contributor.authorEngelter, Stefan Ten_GB
dc.contributor.authorFurie, Karen Len_GB
dc.contributor.authorGiannopoulos, Sotiriosen_GB
dc.contributor.authorGotto, Antonio Men_GB
dc.contributor.authorHannon, Niamhen_GB
dc.contributor.authorJonsson, Fredriken_GB
dc.contributor.authorKapral, Moira Ken_GB
dc.contributor.authorMartí-Fàbregas, Joanen_GB
dc.contributor.authorMartínez-Sánchez, Patriciaen_GB
dc.contributor.authorMilionis, Haralampos Jen_GB
dc.contributor.authorMontaner, Joanen_GB
dc.contributor.authorMuscari, Antonioen_GB
dc.contributor.authorPikija, Slavenen_GB
dc.contributor.authorProbstfield, Jeffreyen_GB
dc.contributor.authorRost, Natalia Sen_GB
dc.contributor.authorThrift, Amanda Gen_GB
dc.contributor.authorVemmos, Konstantinosen_GB
dc.contributor.authorKelly, Peter Jen_GB
dc.date.accessioned2013-01-09T15:49:22Z-
dc.date.available2013-01-09T15:49:22Z-
dc.date.issued2013-01-03-
dc.identifier.citationStatin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials. 2013: Strokeen_GB
dc.identifier.issn1524-4628-
dc.identifier.pmid23287777-
dc.identifier.doi10.1161/STROKEAHA.112.668277-
dc.identifier.urihttp://hdl.handle.net/10147/264761-
dc.description.abstractBackground-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS: The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS: The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSIONS: In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.en_GB
dc.languageENG-
dc.language.isoenen
dc.rightsArchived with thanks to Stroke; a journal of cerebral circulationen_GB
dc.titleStatin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials.en_GB
dc.typeArticleen
dc.contributor.departmentFrom the Neurovascular Unit for Applied Translational Research and Therapeutics, Mater University Hospital/Dublin Academic Medical Centre, University College Dublin, Ireland.en_GB
dc.identifier.journalStroke; a journal of cerebral circulationen_GB
dc.description.provinceLeinsteren

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