Abstract 2633: In-Hospital Initiation of Lipid Lowering Therapy Improves Clinical Outcome in Patients with Acute Ischemic Stroke or Transient Ischemic Attack
Lipid-lowering therapy (LLT) with statin reduces the risk of recurrent stroke and vascular events in ischemic stroke (IS) patients (pts). Although there is benefit in early statin use in acute coronary syndrome, little is known about the timing to start LLT in IS. We evaluated the influence of in-hospital initiation of LLT on the clinical outcomes of IS or transient ischemic attack (TIA) pts. Taiwan Stroke Registry, launched from May 1, 2006, prospectively collected data of IS or TIA pts from the 37 stroke centers nationwide. By July 31, 2007, 12139 adult pts (mean age 68 years, male 60%) were admitted and survived to discharge. The study end points were the composite outcome of recurrent stroke, ischemic heart disease and death from all causes. We examined the association of LLT at discharge with clinical outcomes using Cox proportional hazards models. Overall, there were 3000 (25%) pts receiving LLT at discharge and follow-up data at 6 months were available for 12037 pts (99%). At 6 months, 913 pts (8% of the cohort) had developed ≥1 component of the composite end point, including 120 pts (4%) in LLT group at discharge (n = 2998) and 793 pts (9%) in group without LLT at discharge (n = 9039) (P < 0.0001). In multivariate Cox regression analysis, after adjustment for other clinical factors, age, diabetes mellitus, ischemic heart disease history, national institutes of health stroke scale (NIHSS) score at admission, antiplatelet drug at discharge, antihypertensive drug at discharge and LLT at discharge were found to be independent predictors of the composite end point. LLT at discharge has significant influence on the composite end point at 6 months after discharge (hazard ratio: 0.75; 95% confidence interval: 0.60 to 0.93; P = 0.009). Our data indicate that LLT was underused in this nationwide sample of pts hospitalized for acute IS or TIA. In-hospital initiation of LLT is as effective as antiplatelet and antihypertensive treatment in improving clinical outcome of pts with IS or TIA.