Response to Letter by Reeves Regarding Article, “Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke: The North Dublin Population Stroke Study”
We thank Professor Reeves1 for his interest in our work. As he correctly states, it is possible that treatment selection bias favoring less-impaired patients (confounding by indication) may have partially contributed to the findings reported in the North Dublin cohort. This is an inherent limitation to observational studies examining outcome and medication exposure, including statins. We highlighted this key point in our article,2 and we welcome the opportunity to re-emphasize it, given its importance to the interpretation of our findings.
However, we note that the association of statin therapy with improved outcome was also observed in patients prescribed statins before stroke onset, despite higher prevalence of several factors associated with poor prognosis following stroke in this group. Treatment selection bias is less likely to account for this finding, as stroke severity will not influence prescribing of statins before stroke onset. A similar finding was recently observed in a meta-analysis, where an association was observed between prestroke statin use and good outcome.3
When combined with experimental data from laboratory studies, these observations raise the possibility of a beneficial effect of statins on stroke outcome in humans. We agree that randomized trials of acute statin therapy are needed to resolve the question.
Danielle Ní Chróinín, MB
Peter J. Kelly, MD
Neurovascular Clinical Science Unit
Mater Misericordiae University Hospital/University College
Academic Medical Centre
P.J.K. is the recipient of a Clinician Scientist Award from the Health Research Board of Ireland and research funding from the Irish Heart Foundation.
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- © 2011 American Heart Association, Inc.
- Reeves M
- Ní Chróinín D,
- Callaly EL,
- Duggan J,
- et al
- Biffi A,
- Devan WJ,
- Anderson CD,
- Cortellini L,
- Furie KL,
- Rosand J,
- Rost NS