Abstract T P388: Statin Use is Linked to Lower Risk of Recurrent Vascular Events among Ischemic Stroke Patients with Atrial Fibrillation
Background: The efficacy of statin therapy in the prevention of recurrent stroke and major adverse cardiovascularevents (MACE) was clearly established by the SPARCL trial; but SPARCL excluded patients whose index stroke was due to a presumed cardioembolic mechanism. As such, it remains unclear whether statins are beneficial in cardioembolic stroke patients, particularly those with atrial fibrillation (AF).
Objective: To evaluate the relationship between statin use and future vascular risk reduction among recent ischemic stroke patients with AF
Methods: We analyzed the Taiwan National Health Insurance registry which comprises beneficiaries aged ≥ 18 years. Code ICD-9 was used to identify a primary hospitalization diagnosis of ischemic stroke and AF among subjects encountered between 2003 and 2009. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction; withdrawal from the registry; and last medical claim before 1/1/2011. Patients were divided into 2 groups based on whether statin was prescribed (at least 30 days vs. never used) during the follow-up period. Patients were excluded if they did not take any antithrombotic agent within 30 days before an endpoint. Primary endpoint was MACE (composite of stroke and myocardial infarction) and a key secondary endpoint was any recurrent stroke. Multivariate-adjusted hazard ratio (HR) and 95% CI for the development of events were estimated using Cox models. Model was adjusted for baseline age, gender, hypertension, diabetes, prior stroke, prior myocardial infarction, hyperlipidemia, hospital level, and antithrombotic agent during follow-up.
Results: Among 4455 eligible patients, mean age was 71 years and mean follow-up duration was 2.8 years.Compared to non-statin use, statin use was associated with a significantly lower occurrence of MACE (adjusted HR 0.84, 95% CI 0.72 to 0.99, P=0.04) and recurrent stroke (adjusted HR 0.82, 0.69 to 0.97, P=0.02). Statin use was also linked to lower ischemic stroke risk, but had neutral effects on intracranial hemorrhage and myocardial infarction.
Conclusion: Among patients with an index ischemic stroke and AF, statin use is associated with a lower risk of recurrent vascular events including stroke.
Author Disclosures: M. Lee: None. Y. Wu: None. J.L. Saver: None. J. Lee: None. H. Wang: None. B. Ovbiagele: None.
- © 2015 by American Heart Association, Inc.