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Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or
Jennifer L Dearborn-Tomazos1, Xin Hu2, Dawn M Bravata3,4,5
1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.L.D.-T.).
Insights
Statin therapy deintensification or discontinuation after stroke or TIA in veterans was common and linked to increased mortality. Maintaining moderate- or high-potency statins post-stroke is crucial for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Practice guidelines advocate moderate- to high-potency statin use post-atherosclerotic ischemic stroke or transient ischemic attack (TIA).
- Assessing statin potency patterns before and after hospitalization is key for understanding patient outcomes.
Purpose of the Study:
- To investigate the association between statin potency patterns and mortality in US Veterans after ischemic stroke or TIA.
- To evaluate the impact of statin deintensification or discontinuation on mortality rates.
Main Methods:
- A nationwide sample of US Veterans hospitalized for stroke or TIA in 2011 was analyzed.
- Statin dosing (low, moderate, high potency) was assessed at admission and discharge.
- Logistic regression compared mortality across 6 statin potency patterns, including goal-to-goal, deintensification, and none-to-none.
Main Results:
- Nearly one-third of patients were discharged without statin medication.
- Statin deintensification or no statin treatment at discharge was associated with increased 1-year mortality compared to maintaining goal-potency statins.
- Adjusted odds ratios showed significantly higher mortality for deintensification (1.26) and none-to-none (1.59) groups.
Conclusions:
- Underutilization of statins, including deintensification, is prevalent in veterans post-stroke or TIA.
- Statin deintensification or discontinuation is linked to higher mortality.
- Maintaining guideline-recommended statin therapy post-stroke is associated with improved survival.
Background And Purpose:
Practice guidelines recommend that most patients receive moderate- or high-potency statins after ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin. We tested the association of different patterns of potency for prescribed statin therapy—assessed before admission and at hospital discharge for ischemic stroke or TIA—on mortality in a large, nationwide sample of US Veterans.
Methods:
The study population included patients with an ischemic stroke or TIA occurring during 2011 at any of the 134 Veterans Health Administration facilities. We used electronic outpatient pharmacy files to identify statin dose at hospital admission and within 7 days after hospital discharge. We categorized statin dosing as low, moderate, or high potency; moderate or high potency was considered at goal. We created 6 mutually exclusive groups to reflect patterns of statin potency from hospital admission to discharge: goal to goal, low to goal, goal to low or goal to none (deintensification), none to none, none to low, and low to low. We used logistic regression to compare 30-day and 1-year mortality across statin potency groups.
Results:
The population included 9380 predominately White (71.1%) men (96.3%) who were hospitalized for stroke or TIA. In this sample, 34.1% of patients (n=3194) were discharged off a statin medication. Deintensification occurred in 14.0% of patients (n=1312) and none to none in 20.5% (n=1924). Deintensification and none to none were associated with a higher odds of mortality as compared with goal to goal (adjusted odds ratio 1-year mortality: deintensification versus goal to goal, 1.26 [95% CI, 1.02–1.57]; none to none versus goal to goal, 1.59 [95% CI, 1.30–1.93]). Adjustments for differences in baseline characteristics using propensity weighted scores demonstrated similar results.
Conclusions:
Underutilization of statins, including no treatment or underdosing after stroke (deintensification), was observed in approximately one-third of veterans with ischemic stroke or TIA and was associated with higher mortality when compared with patients who were at goal for statin prescription dosing.
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