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.

中文翻译：

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他汀类药物戒断和坚持治疗对卒中结局的影响

介绍

他汀类药物疗法具有多种公认的益处，已成为预防卒中的最关键进展。我们旨在评估危险因素以及依从性差或他汀类药物中断对缺血性中风临床结局的影响。

方法

这项前瞻性队列研究包括2014年至2018年之间接受急性缺血性卒中的患者。根据他汀类药物的依从性和戒断情况，将连续性患者分为亚组。所有参与者均被随访24个月。结果包括中风复发，主要心血管事件，全因死亡率和功能表现。在缺血性卒中住院后第7天，30天，6个月和2年使用改良的兰金量表评估功能结局。在二级分析中，将结局变量与未接受他汀类药物的患者进行比较。

结果

我们纳入了479例急性缺血性中风患者。平均年龄为58.3，男性为55.0％。没有他汀类药物的患者为96（21.8％），依从性差的患者为150（34.9％），中度依从性的患者为40（9.1％），依从性良好的患者为154（35.0％）。有54例（15.7％）退出治疗。患有高血压，先前卒中和大动脉粥样硬化的患者依从性差（p  <0.05）。依从性差的患者与不良的功能预后和中风复发的发生率显着相关（p  <0.05）。在依从性令人满意的患者中，才发现明显的功能恢复。

结论

他汀类药物的次优使用与中风患者的临床结局明显恶化有关。