Abstract W P269: High vs. Moderate-intensity Statin Therapy After Ischemic Stroke: Findings from PROSPER
Background: Current treatment guidelines recommend high-intensity statin therapy for patients with a history of stroke. However, older patients with higher comorbidity were under-represented in trials and dosing varies in clinical practice. We compared the effectiveness of high vs moderate-intensity statins on clinical outcomes in older patients from the GWTG-Stroke registry.
Methods: We studied statin-naïve ischemic stroke patients ≥65 years from GWTG-Stroke linked to Medicare claims from 2008-2011 who were discharged on statins. Outcomes included home time days (days alive and not in acute or post-acute care facility), major adverse cardiovascular events (MACE), mortality, all-cause, stroke and CV readmission within 2 years of discharge. We estimated unadjusted and adjusted associations between statin intensity and outcomes using negative binomial and Cox proportional hazards models. Inverse-weighted estimates of the probability of high-intensity statin (IPW) were used to adjust for treatment selection.
Results: Of 29,631 ischemic stroke patients discharged on statins, 9,145 (31%) received high-intensity statins. Patients receiving high-intensity statins were younger and had higher LDL-C compared with patients on moderate-intensity statins. The high-intensity statin group had 5 fewer home time days and higher all-cause readmission within 2 years, but other observed outcomes were similar (Table). Except for a slightly higher hazard of all-cause readmission with high-intensity statin use, there were no significant differences in MACE, hemorrhagic stroke, or other outcomes after IPW adjustment (Table).
Conclusions: We found no differences in MACE or home time days within 2 years of initiation of high vs. moderate-intensity statin therapy following ischemic stroke. These findings can inform patients and clinicians regarding the risk-benefit associated with statin dosing after ischemic stroke.
Author Disclosures: M.A. Greiner: None. E. O'Brien: None. Y. Xian: None. D.L. Bhatt: Research Grant; Modest; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company. L. Maisch: None. D. Hannah: None. B. Lindholm: None. E.E. Smith: None. L.H. Schwamm: Research Grant; Modest; PI study funded by the National Institute of Neurological Disorders and Stroke (clinicaltrials.gov/show/NCT01282242) with additional support from Genentech. Consultant/Advisory Board; Modest; Stroke systems consultant to Massachusetts Dept of Health, Scientific consultant regarding trial design and conduct to Lundbeck (international steering committee, DIAS3, 4 trial) and Penumbra (data and safety monitoring committee, Separator 3D trial). Other; Modest; Chair, AHA/ASA GWTG stroke clinical work group. D.M. Olson: None. E.D. Peterson: Research Grant; Modest; Lilly, Johnson & Johnson, Bristol-Myers Squibb, Snofi-Aventis, Merck-Schering Plough partnership. Other; Modest; PI of Data Analytic Center for AHA/American Stroke Association's (ASA) GWTG. G.C. Fonarow: Employment; Modest; University of California (holds a patent on retriever devices for stroke). Research Grant; Significant; National Institutes of Health. Other; Modest; Member, GWTG steering committee. M.J. Pencina: None. A.F. Hernandez: Research Grant; Modest; Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Novartis, Portola Pharmaceuticals. Honoraria; Modest; Amgen, GlaxoSmithKline, Janssen, Novartis.
- © 2015 by American Heart Association, Inc.