Abstract 13376: Early Statin Therapy Improves Clinical Outcomes Than Delayed Statin Treatment in Patients With Acute Ischemic Stroke
Objectives: Recent evidence showed that statin therapy is beneficial in secondary prevention for acute ischemic stroke (IS). But the optimal timing of initiation of statin use is still under debate. We assessed the effect of in-hospital initiation of statin therapy in patients with acute IS.
Methods and Results: We screened the databank of the Bureau of National Health Insurance in Taiwan from January 2000 to December 2000. Patients (n=36,359, mean age 68.9 years, male 55%) who were admitted due to their first IS or transient ischemic attack (TIA) and without prior statin therapy were included in this study. The patients receiving statin treatment after stroke were included and divided into 3 groups according to the timing of statin initiation: immediate use group (n=2,004, mead age 65.7 years, male 48%) were patients receiving statin during hospitalization; early use group (n=1,831, mean age 65 years, male 51%) were patients receiving statin within one year after discharge, and late use group (n=2,669, mean age 65.8 years, male 48%) were patients receiving statin one year later after discharge. The study end point was the composite outcome of recurrent IS, hemorrhagic stroke, TIA and acute coronary event. All eligible patients were followed up for 4 years after discharge and Cox proportional hazards model was used to evaluate the effect of the timing of statin therapy on clinical outcome. At the end of follow-up, patients in immediate use group had better clinical outcome than those in late use group (event rate: 18.3% vs 25.7%, p<0.0001). Immediate statin use was an independent predictor of better clinical outcome after adjusting for other clinical factors (hazard ratio: 0.79; 95% confidence interval: 0.70 – 0.90) when compared with late use group. However, no difference was found in composite outcome between immediate use group and early use group (event rate: 18.3% vs 18.5%, p=0.76). Immediate statin use has no significant impact on the composite outcome when compared with the early use group (hazard ratio: 0.95; 95% confidence interval: 0.82 to 1.10).
Conclusion: Our study showed early statin initiation within one year after IS has the similar beneficial effect as immediate users to improve the clinical outcomes than the delayed users.
- © 2010 by American Heart Association, Inc.