BACKGROUND AND PURPOSE: 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 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). 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.

Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials / NÍ CHRÓINÍN D; ASPLUND K; ASBERG S; CALLALY E; CUADRADO-GODIA E; DÍEZ-TEJEDOR E; DI NAPOLI M; ENGELTER ST; FURIE KL; GIANNOPOULOS S; GOTTO AM JR; HANNON N; JONSSON F; KAPRAL MK; MARTÍ-FÀBREGAS J; MARTÍNEZ-SÁNCHEZ P; MILIONIS HJ; MONTANER J; MUSCARI A; PIKIJA S; PROBSTFIELD J; ROST NS; THRIFT AG; VEMMOS K; KELLY PJ. - In: STROKE. - ISSN 0039-2499. - STAMPA. - 44:(2013), pp. 448-456. [10.1161/STROKEAHA.112.668277]

Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials

MUSCARI, ANTONIO;
2013

Abstract

BACKGROUND AND PURPOSE: 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 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). 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.
2013
Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials / NÍ CHRÓINÍN D; ASPLUND K; ASBERG S; CALLALY E; CUADRADO-GODIA E; DÍEZ-TEJEDOR E; DI NAPOLI M; ENGELTER ST; FURIE KL; GIANNOPOULOS S; GOTTO AM JR; HANNON N; JONSSON F; KAPRAL MK; MARTÍ-FÀBREGAS J; MARTÍNEZ-SÁNCHEZ P; MILIONIS HJ; MONTANER J; MUSCARI A; PIKIJA S; PROBSTFIELD J; ROST NS; THRIFT AG; VEMMOS K; KELLY PJ. - In: STROKE. - ISSN 0039-2499. - STAMPA. - 44:(2013), pp. 448-456. [10.1161/STROKEAHA.112.668277]
NÍ CHRÓINÍN D; ASPLUND K; ASBERG S; CALLALY E; CUADRADO-GODIA E; DÍEZ-TEJEDOR E; DI NAPOLI M; ENGELTER ST; FURIE KL; GIANNOPOULOS S; GOTTO AM JR; HANNON N; JONSSON F; KAPRAL MK; MARTÍ-FÀBREGAS J; MARTÍNEZ-SÁNCHEZ P; MILIONIS HJ; MONTANER J; MUSCARI A; PIKIJA S; PROBSTFIELD J; ROST NS; THRIFT AG; VEMMOS K; KELLY PJ
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/146357
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