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Statin therapy after first stroke reduces 10-year stroke recurrence and improves survival

From the Departments of Internal Medicine (H.J.M., M.K., V.P., M.S.E.) and Neurology (S.G., A.P.K.), University of Ioannina School of Medicine, and Acute Stroke Unit (E.M., K.V.), Department of Clinical Therapeutics, Medical School University of Athens, Greece.

Address correspondence and reprint requests to Dr. Sotirios Giannopoulos, University of Ioannina School of Medicine, University Campus, 45110 Ioannina, Greece sgiannop{at}uoi.gr

Objective: To determine whether statin therapy after hospital discharge affects ischemic stroke recurrence and long-term mortality in patients admitted for a first-ever occurrence of ischemic stroke.

Methods: This was a retrospective observational study involving linked hospitalization and death records. The cohort comprised a series of 794 consecutive, first-ever acute ischemic stroke patients from the Athenian Stroke Registry, admitted to the acute stroke unit and the general medicine and neurology ward of our institutions since January 1997 for whom there was available information covering a 10-year follow-up period. Cox proportional hazards model was used to identify risk factors for stroke recurrence and death.

Results: The recurrence rate was 16.3% among stroke patients not receiving a statin after hospital discharge compared with 7.5% among those who received statin therapy (p = 0.002). Cox regression analyses revealed only statin therapy postdischarge to be a significant independent predictor of stroke recurrence (adjusted hazard ratio [HR], 0.65, 95% confidence interval [CI] 0.39 to 0.97, p < 0.01). Similarly, patients receiving a statin had a significantly lower mortality during the 10-year period after the acute cerebrovascular event (adjusted HR, 0.43; 95% CI 0.29 to 0.61, p < 0.01).

Conclusions: Prescribing statin therapy upon hospital discharge to patients with first-ever acute stroke lowers the risk of 10-year stroke recurrence and improves survival.

Abbreviations: CAD = coronary artery disease; CI = confidence interval; HDL = high-density lipoprotein; HR = hazard ratio; LDL = low-density lipoprotein; OR = odds ratio; RR = relative risk; SPARCL = Stroke Prevention by Aggressive Reduction in Cholesterol Levels; SSS = Scandinavian Stroke Scale.

Disclosure: The authors report no disclosures.

Received October 9, 2008. Accepted in final form February 2, 2009.

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