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Updated: Jun 23, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intensity of statin therapy after ischaemic stroke and long-term outcomes: a nationwide cohort study
Ville Kytö1,2, Julia Åivo3, Jori O Ruuskanen3
1Heart Center, Turku University Hospital and University of Turku, Turku, Finland ville.kyto@utu.fi.
Insights
High-intensity statin therapy after ischaemic stroke (IS) significantly reduces long-term death and recurrent stroke risk. This approach does not increase the risk of intracerebral haemorrhage (ICH), highlighting its importance for secondary prevention.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Statins are crucial for secondary prevention in patients with ischaemic stroke (IS).
- Current recommendations for statin intensity vary, and there is a clinical concern regarding the risk of intracerebral haemorrhage (ICH).
- This study investigates the long-term effects of initial statin intensity post-IS.
Purpose of the Study:
- To evaluate the long-term impact of different initial statin intensities on mortality and key cardiovascular events after ischaemic stroke.
- To assess the association between initial statin intensity and the risk of intracerebral haemorrhage.
Main Methods:
- Retrospective analysis of 45,512 patients initiating high, moderate, or low-intensity statin therapy after IS.
- Utilized national registry data from Finland, with adjustments for confounding factors using multivariable regression.
- Primary outcome: all-cause mortality over 12 years. Secondary outcomes: recurrent IS, cardiovascular death, and ICH, analyzed using competing risk models.
Main Results:
- Higher statin intensity was associated with significantly lower risks of all-cause death, recurrent IS, and cardiovascular death.
- A dose-dependent relationship was observed between statin intensity and reduced risk of recurrent IS and cardiovascular death.
- No significant association was found between initial statin intensity and the occurrence of intracerebral haemorrhage.
Conclusions:
- Initiating high-intensity statin therapy after IS is linked to improved long-term survival and reduced cardiovascular events.
- The intensity of initial statin treatment does not appear to elevate the risk of intracerebral haemorrhage.
- These findings underscore the clinical benefit of utilizing high-intensity statins early in the management of ischaemic stroke patients.
Background:
Statins are essential for secondary prevention after ischaemic stroke (IS). However, statin intensity recommendations differ, and there is a concern about intracerebral haemorrhage (ICH). We studied the long-term impacts of initial statin intensity following IS.
Methods:
Consecutive patients using high-intensity, moderate-intensity or low-intensity statin early after IS (n=45 512) were retrospectively studied using national registries in Finland. Differences were adjusted using multivariable regression. The primary outcome was all-cause death within 12-year follow-up (median 5.9 years). Secondary outcomes were recurrent IS, cardiovascular death and ICH studied using competing risk analyses.
Results:
High-intensity therapy was initially used by 16.0%, moderate-intensity by 73.8% and low-intensity by 10.2%. Risk of death was lower with high-intensity versus moderate-intensity (adjusted HR (adj.HR) 0.92; 95% CI 0.87 to 0.97; number needed to treat (NNT) 32.0), with moderate-intensity versus low-intensity (adj.HR 0.91; 95% CI 0.87 to 0.95; NNT 27.5) and with high-intensity versus low-intensity (adj.HR 0.83; 95% CI 0.78 to 0.89; NNT 14.6) statin. There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS (p<0.0001) and cardiovascular death (p<0.0001). The occurrence of ICH was not associated with initial statin intensity (p=0.646).
Conclusions:
Following IS, more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH. These findings emphasise the importance of high statin intensity shortly after IS.
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