Open AccessEffect of Statin Therapy on Outcomes of Patients With Acute Ischemic Stroke and Atrial Fibrillation
Author(s) -
Choi KangHo,
Seo WooKeun,
Park ManSeok,
Kim JoonTae,
Chung JongWon,
Bang Oh Young,
Kim GyeongMoon,
Song TaeJin,
Kim Bum Joon,
Heo Sung Hyuk,
Jung JinMan,
Oh KyungMi,
Kim Chi Kyung,
Yu Sungwook,
Park KwangYeol,
Kim JeongMin,
Park JongHo,
Choi Jay Chol,
Hwang YangHa,
Kim YongJae
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.013941
Subject(s) - medicine , hazard ratio , atrial fibrillation , stroke (engine) , cardiology , statin , clinical endpoint , proportional hazards model , acute coronary syndrome , cohort study , cohort , myocardial infarction , clinical trial , confidence interval , mechanical engineering , engineering
Background There is insufficient evidence on the effect of statins, particularly high‐intensity statins, in patients with acute ischemic stroke and atrial fibrillation. We investigated the impact of statins on the outcomes in these patients, including those who might be vulnerable to statin therapy and those without clinical atherosclerotic cardiovascular diseases. Methods and Results A total of 2153 patients with acute ischemic stroke and atrial fibrillation were enrolled in the present nationwide, multicenter, cohort study. The primary composite end point was the occurrence of net adverse clinical and cerebral events ( NACCE ; death from any cause, stroke, acute coronary syndrome, or major bleeding) over a 3‐year period based on statin intensity. NACCE rates were lower in patients receiving low‐ to moderate‐intensity (adjusted hazard ratio 0.64; 95% CI : 0.52‐0.78) and high‐intensity statins (hazard ratio 0.51; 95% CI 0.40‐0.66) than in those not receiving statin therapy. High‐intensity statins were associated with a lower risk for NACCE than low‐ to moderate‐intensity statins (hazard ratio 0.76; 95% CI 0.59‐0.96). Subgroup analyses showed that the differences in hazard ratio for 3‐year NACCE favored statin use across all subgroups, including older patients, those with low cholesterol levels, patients receiving anticoagulants, and patients without clinical atherosclerotic cardiovascular diseases. Magnified benefits of high‐intensity statins compared with low‐ to moderate‐intensity statins were observed in patients who underwent revascularization therapy and those under 75 years of age. Conclusions Statins, particularly high‐intensity statins, could reduce the risk for NACCE in patients with acute ischemic stroke and atrial fibrillation; this needs to be further explored in randomized controlled trials.