The influence of statin withdrawal and adherence on stroke outcomes
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ORIGINAL ARTICLE
The influence of statin withdrawal and adherence on stroke outcomes Bruno Kusznir Vitturi 1
&
Rubens José Gagliardi 1
Received: 25 March 2020 / Accepted: 3 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Introduction With multiple proven benefits, statin therapy has become the most critical advance in stroke prevention. We aimed to evaluate the risk factors and the effect of poor adherence or statin interruption on the clinical outcomes of ischemic stroke. Methods This prospective cohort study included patients admitted with acute ischemic stroke between 2014 and 2018. Consecutive patients were distinguished into subgroups according to the adherence and withdrawal of statin. All participants were followed for 24 months. The outcomes included stroke recurrence, major cardiovascular events, all-cause mortality, and functional performance. Functional outcome was assessed using the modified Rankin Scale at 7 days, 30 days, 6 months, and 2 years after hospital admission for ischemic stroke. In a secondary analysis, outcome variables were compared with statin-naïve patients. Results We included 479 patients with acute ischemic stroke. The mean age was 58.3, and 55.0% were male. There were 96 (21.8%) patients who received no statin, 150 (34.9%) patients with poor adherence, 40 (9.1%) patients with intermediate adherence, and 154 (35.0%) patients with good adherence. There were 54 (15.7%) cases of withdrawal of treatment. Patients with hypertension, previous stroke, and large-artery atherosclerosis were associated with poor adherence (p < 0.05). Those with poor adherence were significantly associated with worse functional outcomes and a higher incidence of stroke recurrence (p < 0.05). Significant functional recovery was just seen in patients with satisfactory adherence. Conclusion The suboptimal use of statins is associated with significantly worse clinical outcomes in stroke patients. Keywords Stroke . Ischemic stroke . Outcomes . Statins . Adherence
Introduction Stroke is one of the leading causes of death and disability worldwide [1]. Statin therapy has become the most critical advance in stroke prevention since the introduction of aspirin and blood pressure-lowering therapies [2]. Expert consensus guidelines recommend statin treatment for patients who have experienced an ischemic stroke or transient ischemic attack due to large- or small-artery atherosclerosis [3]. Over the past decade, many clinical trials have evaluated the efficacy and
* Bruno Kusznir Vitturi [email protected] 1
Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
safety of statins after a stroke, and their positive results led to an increase in the use of statins for these patients [4]. In addition to their cholesterol-lowering effect, statins have also been proved to provide pleiotropic non-cholesterol-dependent effects to reduce mortality and improve functional outcomes in stroke patients [5]. However, in rou
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