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Statin use and sex-specific stroke outcomes in patients with vascular disease
Cheryl D Bushnell1, Jeffrey Griffin, L Kristin Newby
1Center for Cerebrovascular Disease, Duke University Medical Center, Durham, NC 27710, USA. Cheryl.bushnell@duke.edu
Insights
Statin use lowers stroke risk but does not affect stroke severity or mortality. Women experience more severe strokes than men, irrespective of statin use or other factors.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Statins are known to reduce stroke risk in patients with coronary heart disease.
- However, the impact of statin therapy on stroke outcomes, particularly concerning sex differences, remains unclear.
Purpose of the Study:
- To investigate the association between statin use and sex-specific stroke incidence, severity, and mortality.
- To determine if sex influences the effectiveness of statins in mitigating stroke outcomes.
Main Methods:
- Pooled data from three clinical trials (SYMPHONY and BRAVO) involving oral glycoprotein IIb/IIIa inhibitors.
- Compared stroke outcomes between 8,191 baseline statin users and 14,752 non-users.
- Utilized proportional hazards regression for time-to-event data and the Canadian Neurological Scale (CNS) for stroke severity assessment.
Main Results:
- Statin users exhibited a reduced risk of stroke (HR, 0.72; 95% CI, 0.53 to 0.97) after risk adjustment.
- No significant differences were observed in stroke mortality or severity between statin users and non-users.
- Women experienced more severe strokes than men (median CNS=9.5 vs 10.5), even after adjusting for statin use and other covariates.
Conclusions:
- Statin use is linked to a decreased risk of stroke in patients within these trials.
- Statin therapy did not influence stroke severity or mortality.
- Women consistently had more severe strokes than men, a disparity not explained by statin use or baseline characteristics.
Background And Purpose:
Although statins reduce the risk of stroke in patients with coronary heart disease, possible differing effects of statins on stroke outcomes based on sex remain uncertain. We investigated the relationships between statin use and sex-specific stroke incidence, severity, and mortality.
Methods:
Data from 3 trials of oral glycoprotein IIb/IIIa inhibitors (first and second Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes [SYMPHONY] and Blockade of the glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion [BRAVO]) were pooled and stroke outcomes compared among 8191 baseline statin users versus 14,752 nonusers. Time-to-event data were modeled with proportional hazards regression. Stroke severity was assessed retrospectively with the Canadian Neurological Scale (CNS) based on records with scoreable neurological examinations.
Results:
A total of 217 subjects had strokes (0.95%). Statin users had a lower risk of stroke in unadjusted (hazard ratio [HR], 0.69; 95% CI, 0.51 to 0.92) and risk-adjusted models (HR, 0.72; 95% CI, 0.53 to 0.97). There was no difference in stroke mortality with statin use (P=0.8). CNS scores could be assigned to 106 of the subjects, with no difference in severity among statin users and nonusers (median CNS=10.5 in users versus CNS=9.75 in nonusers; P=0.14). Women had more severe strokes than men (median CNS=10.5 in men versus 9.5 in women; Poisson regression P=0.035). Women had more severe strokes after adjustment for statin use (P=0.03) and the combination of statin use, atrial fibrillation, and age (P=0.03).
Conclusions:
In patients included in these clinical trials of oral glycoprotein IIb/IIIa inhibitors, statin use is associated with a reduced risk of stroke but not severity or mortality. Women had more severe strokes than men, a difference that was not explained by baseline characteristics or statin use.
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