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

• Published in: Stroke (1970) Vol. 44; no. 2; pp. 448 - 456
• Main Authors: NI CHROININ, Danielle, ASPLUND, Kjell, GOTTO, Antonio M, HANNON, Niamh, JONSSON, Fredrik, KAPRAL, Moira K, MARTI-FABREGAS, Joan, MARTINEZ-SANCHEZ, Patricia, MILIONIS, Haralampos J, MONTANER, Joan, MUSCARI, Antonio, PIKIJA, Slaven, ASBERG, Signild, PROBSTFIELD, Jeffrey, ROST, Natalia S, THRIFT, Amanda G, VEMMOS, Konstantinos, KELLY, Peter J, CALLALY, Elizabeth, CUADRADO-GODIA, Elisa, DIEZ-TEJEDOR, Exuperio, DI NAPOLI, Mario, ENGELTER, Stefan T, FURIE, Karen L, GIANNOPOULOS, Sotirios
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2013
• Subjects: Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - drug therapy; Brain Ischemia - epidemiology; Brain Ischemia - mortality; cerebral infarction; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; ischemia; Medical sciences; Neurology; neuroprotective agents; outcomes assessment; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic - methods; Randomized Controlled Trials as Topic - trends; stroke; Stroke - drug therapy; Stroke - epidemiology; Stroke - mortality; therapy; Thrombolytic Therapy - methods; Thrombolytic Therapy - trends; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Cerebral infarction; Stroke; Nervous system diseases; Prognosis; therapy; Cardiovascular disease; outcomes assessment; Statin derivative; Neuroprotective agent; Cerebral disorder; ischemia; Vascular disease; Treatment; neuroprotective agents; Central nervous system disease; Brain ischemia; Cerebrovascular disease; Antilipemic agent
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.112.668277

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. 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. 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 restricted to 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). 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.