SAN DIEGO—Stroke severity may be lower among patients who took statins before their stroke than among those who did not take statins, according to research presented at the 2014 International Stroke Conference. Statin users may also have a higher chance of a good outcome after stroke at hospital discharge than nonusers.
In animal models of stroke, pretreatment with a statin appeared to provide neuroprotection during subsequent ischemia and to aid in neurorestoration after ischemic injury. To examine the effect of prestroke statin use on initial stroke severity and early stroke recovery in humans, Jay Chol Choi, MD, PhD, of Jeju National University in Jeju-si, South Korea, and colleagues analyzed a large data set from a multicenter stroke registry in South Korea.
Statin Users Were More Likely to Be Female
The investigators included all patients with acute ischemic stroke who arrived at the hospital within 48 hours of symptom onset. Patients with prior disability and those with transient ischemic attack were excluded from the study. Patients also were excluded if their modified Rankin scale (mRs) score at discharge was unavailable and if they were treated with thrombolytic therapy.
The study’s primary outcome was initial stroke severity, as measured by an initial NIH Stroke Scale (NIHSS) score. The secondary outcome was the mRs score at discharge. The researchers analyzed the data using various methods, including analysis of covariance and multivariable analysis. Because the group expected baseline characteristics to differ between statin users and nonusers, they performed propensity score analysis in addition to classical multivariable analysis.
A total of 8,340 patients were enrolled in the study, and 12 patients were taking statins before the index stroke. Statin users were more likely to be older, female, and to have vascular risk factors, except for smoking, than nonusers. Large artery atherosclerosis and cardioembolic stroke were more common among statin users than among nonusers. In addition, all prestroke medications, including antiplatelets and anticoagulants, were more commonly used among statin users than nonusers.
Likelihood of Good Outcome Was Higher for Statin Users
The mean initial NIHSS score was 4.6 among statin users, compared with 5.4 among nonusers. The difference between the two groups was statistically significant. When the investigators adjusted the data for other covariates, the difference was slightly smaller, but still statistically significant.
Statin users were more likely to have an mRs of 0, 1, or 2 at discharge, compared with nonusers. In addition, the likelihood of a good outcome at discharge was an average of 40% to 50% greater among statin users, compared with nonusers. The chance of a one-point decrease in mRs score also was approximately 30% greater among statin users, compared with nonusers.
“The current analysis suggests that prestroke statin use might have a dual effect of reducing stroke severity at presentation, as well as enhancing early stroke recovery in patients with stroke, just as with animal models of stroke,” concluded Dr. Choi.
—Erik Greb