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Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation.

Alexander C Flint1, Carol Conell2, Xiushui Ren2

  • 1From the Division of Research, Kaiser Permanente Northern California, Oakland, (A.C.F., C.C.); Department of Neuroscience (A.C.F., S.L.C., V.A.R.) and Department of Cardiology (X.R.), Kaiser Permanente, Redwood City, CA; Department of Neurology, Cornell University, New York, NY (H.K.); and Department of Neurology, University of Texas at Austin (S.C.J.). alexander.c.flint@kp.org.

Stroke
|June 10, 2017
PubMed
Summary

High statin adherence significantly lowers recurrent ischemic stroke risk in patients with atrial fibrillation (AFib), similar to those without AFib. This supports using statins for secondary stroke prevention in all patients.

Keywords:
atrial fibrillationhydroxymethylglutaryl-CoA reductase inhibitorsinternational normalized ratiostrokewarfarin

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Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Pharmacology

Background:

  • Outpatient statin therapy is established for secondary stroke prevention in atherothrombotic ischemic stroke.
  • The efficacy of statins in preventing recurrent ischemic stroke in patients with atrial fibrillation (AFib) remains less understood.

Purpose of the Study:

  • To investigate the association between statin adherence and the risk of recurrent ischemic stroke.
  • To compare this association in patients with and without atrial fibrillation (AFib).

Main Methods:

  • Retrospective cohort study of 6116 ischemic stroke patients discharged on statins.
  • Statin adherence measured by percentage of days covered over a 5-year period.
  • Multivariable survival models analyzed recurrent ischemic stroke risk over 3 years, adjusting for covariates.

Main Results:

  • Higher statin adherence (percentage of days covered) correlated with lower low-density lipoprotein levels.
  • Increased statin adherence significantly reduced recurrent ischemic stroke risk in patients without AFib (HR, 0.78; 95% CI, 0.63-0.97).
  • Increased statin adherence also significantly reduced recurrent ischemic stroke risk in patients with AFib (HR, 0.59; 95% CI, 0.43-0.81), robust to warfarin INR control.

Conclusions:

  • Statin adherence is strongly associated with reduced recurrent ischemic stroke risk in patients with AFib.
  • The protective effect of statin adherence is comparable between patients with and without AFib.
  • Atrial fibrillation status should not preclude the use of statins for secondary stroke prevention.