This Article Full Text Full Text (PDF) All Versions of this Article: 39/6/1779    most recent STROKEAHA.107.501700v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Reeves, M. J. PubMed PubMed Citation Articles by Reeves, M. J. Related Collections Other Treatment Acute Cerebral Infarction Other Stroke Treatment - Medical

(Stroke. 2008;39:1779.)
© 2008 American Heart Association, Inc.

Original Contributions

Effect of Pretreatment With Statins on Ischemic Stroke Outcomes

Mathew J. Reeves, PhD; Julia Warner Gargano, MS; Zhehui Luo, PhD; Andrew J. Mullard, MS; Bradley S. Jacobs, MD; Arshad Majid, MD for the Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators

From the Department of Epidemiology (M.J.R., J.W.G., Z.L., A.J.M.) and the Department of Neurology & Ophthalmology (A.M.), Michigan State University, East Lansing; and the Division of Neurology, Department of Internal Medicine (B.S.J.), Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Correspondence to Mathew Reeves, PhD, Department of Epidemiology, Michigan State University, B601 West Fee Hall, East Lansing, Michigan 48824. E-mail reevesm{at}msu.edu

Background and Purpose— Statins reduce the risk of stroke in at-risk populations and may improve outcomes in patients taking statins before an ischemic stroke (IS). Our objectives were to examine the effects of pretreatment with statins on poor outcome in IS patients.

Methods— Over a 6-month period all acute IS admissions were prospectively identified in 15 hospitals participating in a statewide acute stroke registry. Poor stroke outcome was defined as modified Rankin score 4 at discharge (ie, moderate-severe disability or death). Multivariable logistic regression models and matched propensity score analyses were used to quantify the effect of statin pretreatment on poor outcome.

Results— Of 1360 IS patients, 23% were using statins before their stroke event and 42% had a poor stroke outcome. After multivariable adjustment, pretreatment with statins was associated with lower odds of poor outcome (OR=0.74, 95% CI 0.52, 1.02). A significant interaction (P<0.01) was found between statin use and race. In whites, statins were associated with statistically significantly lower odds of poor outcome (OR=0.61, 95% CI 0.42, 0.86), but in blacks statins were associated with a nonstatistically significant increase in poor outcome (OR=1.82, 95% CI 0.98, 3.39). Matched propensity score analyses were consistent with the multivariable model results.

Conclusions— Pretreatment with statins was associated with better stroke outcomes in whites, but we found no evidence of a beneficial effect of statins in blacks. These findings indicate the need for further studies, including randomized trials, to examine differential effects of statins on ischemic stroke outcomes among whites and blacks.

Key Words: ischemic stroke • statins • outcome