Published Online
on March 27, 2008

A more recent version of this article appeared on June 1, 2008

This Article 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 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 Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Reeves, M. J. Search for Related Content PubMed PubMed Citation Articles by Reeves, M. J. Pubmed/NCBI databases Medline Plus Health Information Cholesterol Statins Stroke Related Collections Other Treatment Acute Cerebral Infarction Other Stroke Treatment - Medical

Submitted on August 24, 2007
Revised on November 9, 2007
Accepted on November 14, 2007

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.

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				L. B. Goldstein, P. Amarenco, J. Zivin, M. Messig, I. Altafullah, A. Callahan, M. Hennerici, M. J. MacLeod, H. Sillesen, R. Zweifler, et al. Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial Stroke, November 1, 2009; 40(11): 3526 - 3531. [Abstract] [Full Text] [PDF]

				A. A. Rabinstein Statins Prevent Stroke Recurrences... But Can They Improve Stroke Outcome? Stroke, November 1, 2009; 40(11): 3413 - 3414. [Full Text] [PDF]

				N. Meier, K. Nedeltchev, C. Brekenfeld, A. Galimanis, U. Fischer, O. Findling, L. Remonda, G. Schroth, H. P. Mattle, and M. Arnold Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, May 1, 2009; 40(5): 1729 - 1737. [Abstract] [Full Text] [PDF]

				K. Tsuda Stains and Nitric Oxide Production Against Ischemic Stroke Stroke, November 1, 2008; 39(11): e170 - e170. [Full Text] [PDF]

				M. J. Reeves, J. W. Gargano, A. Majid, B. S. Jacobs, and for the Paul Coverdell National Acute Stroke Regis Response to Letter by Tsuda Stroke, November 1, 2008; 39(11): e171 - e171. [Full Text] [PDF]