Statin Therapy and Outcome After Ischemic Stroke Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials

被引:207
作者
Chroinin, Danielle Ni [1 ]
Asplund, Kjell [2 ]
Asberg, Signild [3 ]
Callaly, Elizabeth [1 ]
Cuadrado-Godia, Elisa [4 ]
Diez-Tejedor, Exuperio [5 ,6 ]
Di Napoli, Mario [7 ,8 ]
Engelter, Stefan T. [9 ]
Furie, Karen L. [10 ]
Giannopoulos, Sotirios [11 ]
Gotto, Antonio M., Jr. [12 ]
Hannon, Niamh [1 ]
Jonsson, Fredrik [2 ]
Kapral, Moira K. [13 ]
Marti-Fabregas, Joan [14 ]
Martinez-Sanchez, Patricia [5 ,6 ]
Milionis, Haralampos J. [11 ]
Montaner, Joan [15 ,16 ]
Muscari, Antonio [17 ]
Pikija, Slaven [18 ]
Probstfield, Jeffrey [19 ,20 ]
Rost, Natalia S. [10 ]
Thrift, Amanda G. [21 ,22 ]
Vemmos, Konstantinos [23 ]
Kelly, Peter J. [1 ]
机构
[1] Natl Univ Ireland Univ Coll Dublin, Neurovasc Unit Appl Translat Res & Therapeut, Mater Univ Hosp, Dublin Acad Med Ctr, Dublin, Ireland
[2] Umea Univ Hosp, Dept Med, S-90185 Umea, Sweden
[3] Uppsala Univ, Dept Med Sci, Uppsala, Sweden
[4] Hosp del Mar IMIM, Dept Neurol, Barcelona, Spain
[5] Univ Autonoma Madrid, Dept Neurol, La Paz Univ Hosp, Madrid, Spain
[6] Univ Autonoma Madrid, Stroke Ctr, La Paz Univ Hosp, Madrid, Spain
[7] San Camillo deLellis Gen Hosp, Neurol Serv, Rieti, Italy
[8] Ctr Cardiovasc Med & Cerebrovasc Dis Prevent, SMDN, Laquila, Italy
[9] Univ Basel Hosp, Dept Neurol, Basel, Switzerland
[10] Massachusetts Gen Hosp, J Philip Kistler Stroke Res Ctr, Ctr Human Genet Res, Boston, MA 02114 USA
[11] Univ Ioannina, Sch Med, GR-45110 Ioannina, Greece
[12] Weill Cornell Med Coll, New York, NY USA
[13] Toronto Gen Hosp, Inst Clin Evaluat Sci, Toronto, ON, Canada
[14] Hosp Santa Creu & Sant Pau, Barcelona, Spain
[15] Autonomous Univ Barcelona, Hosp Vall dHebron, Barcelona, Spain
[16] Autonomous Univ Barcelona, Vall dHebron Res Inst VHIR, Barcelona, Spain
[17] Univ Bologna, S Orsola Malpighi Hosp, Bologna, Italy
[18] Gen Hosp Varazdin, Varazhdin, Croatia
[19] Univ Washington, Dept Med, Seattle, WA USA
[20] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[21] Monash Univ, Monash Med Ctr, Stroke & Ageing Res Ctr, Dept Med, Clayton, Vic, Australia
[22] Natl Stroke Res Inst, Heidelberg, Vic, Australia
[23] Univ Athens, Dept Therapeut, Alexandra Hosp, GR-10679 Athens, Greece
基金
英国医学研究理事会; 美国国家卫生研究院;
关键词
cerebral infarction; ischemia; neuroprotective agents; outcomes assessment; stroke; therapy; COA REDUCTASE INHIBITOR; NITRIC-OXIDE SYNTHASE; INFARCT VOLUME; ACUTE-PHASE; INTRAVENOUS THROMBOLYSIS; CEREBRAL-ISCHEMIA; LIPID PROFILE; PRETREATMENT; PREVENTION; ONSET;
D O I
10.1161/STROKEAHA.112.668277
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. Methods-The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (<= 72 hours after stroke), and (2) thrombolysis-treated patients. Results-The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80;95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). Conclusion-In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed. (Stroke. 2013;44:448-456.)
引用
收藏
页码:448 / 456
页数:9
相关论文
共 74 条
[1]   Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator [J].
Alvarez-Sabin, Jose ;
Huertas, Rafael ;
Quintana, Manolo ;
Rubiera, Marta ;
Delgado, Pilar ;
Ribo, Marc ;
Molina, Carlos A. ;
Montaner, Joan .
STROKE, 2007, 38 (03) :1076-1078
[2]   Statins in stroke prevention and carotid atherosclerosis -: Systematic review and up-to-date meta-analysis [J].
Amarenco, P ;
Labreuche, J ;
Lavallée, P ;
Touboul, PJ .
STROKE, 2004, 35 (12) :2902-2909
[3]   Mevastatin, an HMG-CoA reductase inhibitor, reduces stroke damage and upregulates endothelial nitric oxide synthase in mice [J].
Amin-Hanjani, S ;
Stagliano, NE ;
Yamada, M ;
Huang, PL ;
Liao, JK ;
Moskowitz, MA .
STROKE, 2001, 32 (04) :980-985
[4]  
[Anonymous], 2010, SURGERY, DOI DOI 10.1016/J.SURG.2009.06.030
[5]  
[Anonymous], 2002, JAMA, V288, P2998
[6]   Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia? [J].
Arboix, Adria ;
Garcia-Eroles, Luis ;
Oliveres, Montserrat ;
Targa, Cecilia ;
Balcells, Miquel ;
Massons, Joan .
BMC NEUROLOGY, 2010, 10
[7]   Protective effects of statin involving both eNOS and tPA in focal cerebral ischemia [J].
Asahi, M ;
Huang, ZH ;
Thomas, S ;
Yoshimura, S ;
Sumii, T ;
Mori, T ;
Qiu, JH ;
Amin-Hanjani, S ;
Huang, PL ;
Liao, JK ;
Lo, EH ;
Moskowitz, MA .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2005, 25 (06) :722-729
[8]   Ischemic Stroke and Secondary Prevention in Clinical Practice A Cohort Study of 14 529 Patients in the Swedish Stroke Register [J].
Asberg, Signild ;
Henriksson, Karin M. ;
Farahmand, Bahman ;
Asplund, Kjell ;
Norrving, Bo ;
Appelros, Peter ;
Stegmayr, Birgitta ;
Asberg, Kerstin Hulter ;
Terent, Andreas .
STROKE, 2010, 41 (07) :1338-1342
[9]   Statin administration prior to ischaemic stroke onset and survival: exploratory evidence from matched treatment-control study [J].
Aslanyan, S ;
Weir, CJ ;
McInnes, GT ;
Reid, JL ;
Walters, MR ;
Lees, KR .
EUROPEAN JOURNAL OF NEUROLOGY, 2005, 12 (07) :493-498
[10]   Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins [J].
Baigent, C ;
Keech, A ;
Kearney, PM ;
Blackwell, L ;
Buck, G ;
Pollicino, C ;
Kirby, A ;
Sourjina, T ;
Peto, R ;
Collins, R ;
Simes, J .
LANCET, 2005, 366 (9493) :1267-1278