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The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies

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Abstract

Background

Several real-world observational studies have investigated the association between statin treatment and outcomes of cardioembolic stroke. However, substantial uncertainties remain about this association.

Objective

We aimed to perform a systematic review and meta-analysis to determine the effect of statin treatment on the outcomes of cardioembolic stroke.

Methods

We systematically searched the PubMed and Embase databases for relevant clinical studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) with a random-effects model were used to assess the outcomes of interest.

Results

A total of 18 observational studies published between 2009 and 2020 were included. No randomized clinical trial was found. Compared with non-statin treatment, statin treatment was not associated with a decreased risk of stroke recurrence in patients with cardioembolic stroke [PWCS] (RR, 0.93; 95% CI 0.82–1.06). However, compared with non-statin treatment, statin treatment was associated with a lower risk of all-cause death (RR, 0.59; 95% CI 0.49–0.73) and better functional outcomes (RR, 0.67; 95% CI 0.47–0.97) in PWCS. There was no significant association between statin treatment and major bleeding event risk in PWCS (RR, 0.35; 95% CI 0.06–2.16). Compared with non-statin treatment, statin treatment was not associated with a decreased risk of coronary atherosclerotic disease in PWCS (RR, 1.04; 95% CI 0.96–1.11).

Conclusions

Although the use of statins does not enhance the prevention of stroke recurrence in PWCS, statin treatment is associated with improved clinical outcomes in PWCS. Statins play a beneficial role in the treatment of cardioembolic stroke.

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Authors and Affiliations

  1. Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China

    Tao Xu, You Wang, Jinxian Yuan & Yangmei Chen

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  1. Tao Xu
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Correspondence to Yangmei Chen.

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Funding

This study was supported by the National Science Foundation of China (no. 81901315 and no. 81771390).

Conflicts of Interest/Competing Interests

Tao Xu, You Wang, Jinxian Yuan, and Yangmei Chen have no conflicts of interest that are directly relevant to the content of this article.

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Data are available to qualified investigators on request to the corresponding author.

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Authors’ Contributions

TX: study design, literature search and selection, acquisition, analysis, and interpretation of data, draft of the manuscript; YW: literature search and selection, acquisition, analysis, and interpretation of data; JXY: study design, statistical analysis, draft of the manuscript; YMC: study design, interpretation of data, statistical analysis, and draft of the manuscript.

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Xu, T., Wang, Y., Yuan, J. et al. The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies. CNS Drugs 35, 717–726 (2021). https://doi.org/10.1007/s40263-021-00829-6

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