on April 27, 2006
Published online before print April 27, 2006, doi: 10.1161/01.STR.0000221315.60282.ca
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Submitted on March 6, 2006
From the Duke Center for Cerebrovascular Disease (C.D.B., L.B.G., C.A.G.), Department of Medicine (Neurology), and Duke Clinical Research Institute and Department of Medicine (Cardiology) (J.G., L.K.N., K.W.M., R.A.H., R.M.C.), Duke University Medical Center, Durham, NC; Green Lane Cardiovascular Research (H.D.W.), Auckland City Hospital, New Zealand; National Health and Medical Research Council Clinical Trials Centre (R.J.S.), Camperdown, New South Wales, Australia; Cleveland Clinic Foundation (E.J.T.), Case Western Reserve University, Ohio; and Department of Neurology (J.D.E.), Rhode Island Hospital, Brown University, Providence, Rhode Island. * To whom correspondence should be addressed. E-mail: Cheryl.bushnell{at}duke.edu.
Background and Purpose--Although statins reduce the risk of stroke in patients with coronary heart disease, possible differing effects of statins on stroke outcomes based on sex remain uncertain. We investigated the relationships between statin use and sex-specific stroke incidence, severity, and mortality. Methods--Data from 3 trials of oral glycoprotein IIb/IIIa inhibitors (first and second Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes [SYMPHONY] and Blockade of the glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion [BRAVO]) were pooled and stroke outcomes compared among 8191 baseline statin users versus 14 752 nonusers. Time-to-event data were modeled with proportional hazards regression. Stroke severity was assessed retrospectively with the Canadian Neurological Scale (CNS) based on records with scoreable neurological examinations. Results--A total of 217 subjects had strokes (0.95%). Statin users had a lower risk of stroke in unadjusted (hazard ratio [HR], 0.69; 95% CI, 0.51 to 0.92) and risk-adjusted models (HR, 0.72; 95% CI, 0.53 to 0.97). There was no difference in stroke mortality with statin use (P=0.8). CNS scores could be assigned to 106 of the subjects, with no difference in severity among statin users and nonusers (median CNS=10.5 in users versus CNS=9.75 in nonusers; P=0.14). Women had more severe strokes than men (median CNS=10.5 in men versus 9.5 in women; Poisson regression P=0.035). Women had more severe strokes after adjustment for statin use (P=0.03) and the combination of statin use, atrial fibrillation, and age (P=0.03). Conclusions--In patients included in these clinical trials of oral glycoprotein IIb/IIIa inhibitors, statin use is associated with a reduced risk of stroke but not severity or mortality. Women had more severe strokes than men, a difference that was not explained by baseline characteristics or statin use.
Revised on March 22, 2006
Accepted on March 27, 2006
Statin Use and Sex-Specific Stroke Outcomes in Patients With Vascular Disease
Cheryl D. Bushnell MD, MHS*;
Key words: stroke assessment • stroke outcome