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The influence of statin withdrawal and adherence on stroke outcomes
Bruno Kusznir Vitturi1, Rubens José Gagliardi2
1Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo, 01221-020, Brazil. z_azul@hotmail.com.
Insights
Suboptimal statin use in ischemic stroke patients is linked to worse outcomes. Good adherence to statin therapy is crucial for better functional recovery and reduced stroke recurrence.
Area of Science:
- Cardiovascular Research
- Neurology
- Pharmacology
Background:
- Statin therapy is a cornerstone in preventing strokes due to its proven benefits.
- Understanding factors influencing statin adherence is vital for optimizing patient outcomes.
Purpose of the Study:
- To investigate risk factors associated with poor statin adherence or interruption in ischemic stroke patients.
- To evaluate the impact of suboptimal statin use on clinical outcomes, including stroke recurrence and functional recovery.
Main Methods:
- A prospective cohort study of 479 acute ischemic stroke patients (2014-2018) was conducted.
- Patients were categorized based on statin adherence and withdrawal, with follow-up for 24 months.
- Outcomes assessed included stroke recurrence, major cardiovascular events, mortality, and functional performance using the modified Rankin Scale.
Main Results:
- Poor statin adherence was associated with hypertension, prior stroke, and large-artery atherosclerosis.
- Patients with poor adherence or statin withdrawal experienced worse functional outcomes and increased stroke recurrence.
- Satisfactory statin adherence was linked to significant functional recovery.
Conclusions:
- Suboptimal statin use, including poor adherence and withdrawal, significantly worsens clinical outcomes in ischemic stroke patients.
- Maintaining good statin adherence is critical for improving functional recovery and reducing secondary stroke events.
Introduction:
With multiple proven benefits, statin therapy has become the most critical advance in stroke prevention. We aimed to evaluate the risk factors and the effect of poor adherence or statin interruption on the clinical outcomes of ischemic stroke.
Methods:
This prospective cohort study included patients admitted with acute ischemic stroke between 2014 and 2018. Consecutive patients were distinguished into subgroups according to the adherence and withdrawal of statin. All participants were followed for 24 months. The outcomes included stroke recurrence, major cardiovascular events, all-cause mortality, and functional performance. Functional outcome was assessed using the modified Rankin Scale at 7 days, 30 days, 6 months, and 2 years after hospital admission for ischemic stroke. In a secondary analysis, outcome variables were compared with statin-naïve patients.
Results:
We included 479 patients with acute ischemic stroke. The mean age was 58.3, and 55.0% were male. There were 96 (21.8%) patients who received no statin, 150 (34.9%) patients with poor adherence, 40 (9.1%) patients with intermediate adherence, and 154 (35.0%) patients with good adherence. There were 54 (15.7%) cases of withdrawal of treatment. Patients with hypertension, previous stroke, and large-artery atherosclerosis were associated with poor adherence (p < 0.05). Those with poor adherence were significantly associated with worse functional outcomes and a higher incidence of stroke recurrence (p < 0.05). Significant functional recovery was just seen in patients with satisfactory adherence.
Conclusion:
The suboptimal use of statins is associated with significantly worse clinical outcomes in stroke patients.
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