Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials.
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
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
Author
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
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
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Editors
Other Contributors
Date
2013-01-03
Date Submitted
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Planned Date
Start Date
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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.
Language
en
ISSN
1524-4628
eISSN
ISBN
DOI
10.1161/STROKEAHA.112.668277
PMID
23287777