Intensive versus non-intensive statin therapy in patients with ischemic stroke: A systematic review and meta-analysis

Intensive and non-intensive statin therapies are commonly used to manage ischemic stroke, a major cause of death and disability worldwide. However, the ideal statin therapy intensity in the acute phase remains uncertain. This study evaluates whether intensive statin therapy leads to better functional and clinical outcomes than non-intensive therapy in patients with ischemic stroke.

A comprehensive search of four databases was conducted from inception through January 2025. Eligible studies included randomized controlled trials (RCTs) or observational studies comparing intensive versus non-intensive statin therapy in acute ischemic stroke patients. Meta-analysis was conducted using a random-effects model in Review Manager.

11 studies involving 53.118 patients met the inclusion criteria. Intensive statin therapy significantly improved good functional outcomes based on the modified Rankin scale (mRS 0-2) at three months (78.1 % vs. 75.1 %; OR 1.12; 95 % CI 1.05, 1.19; p = 0.0008; I² = 0 %) and favorable functional outcomes (mRS 0-3) (87.1 % vs. 85.0 %; OR 1.14; 95 % CI 1.05, 1.23; p = 0.001; I² = 0 %). However, intensive therapy was associated with a higher risk of intracerebral hemorrhage (0.8 % vs. 0.5 %; OR 1.60; 95 % CI 1.01, 2.54; p = 0.05; I² = 53 %). No significant differences were observed between groups regarding stroke recurrence, bleeding events, acute coronary syndrome and all-cause mortality.

Intensive statin therapy improves functional recovery at three months in ischemic stroke patients but does not significantly affect stroke recurrence, bleeding events, or mortality. However, it is associated with an increased risk of ICH.