Glycemic Status and Effect of Immediate Intensive Statin on Mild Ischemic Stroke: A Subgroup Analysis of the INSPIRES...

Area of Science:

• Neurology
• Cardiology
• Endocrinology

Background:

• Ischemic stroke is a leading cause of disability.
• Glycemic status, particularly type 2 diabetes mellitus (T2DM), can influence stroke outcomes and treatment efficacy.
• Optimizing statin therapy in stroke patients based on glycemic status is crucial for improving functional recovery.

Purpose of the Study:

• To evaluate the effects of intensive statin therapy on functional outcomes in ischemic stroke patients stratified by glycemic status.
• To determine if glycemic status modifies the benefit of immediate-intensive statin therapy post-stroke.

Main Methods:

• Subgroup analysis of the INSPIRES trial involving 6100 ischemic stroke patients.
• Patients were categorized into three groups: without T2DM, newly diagnosed T2DM, and history of T2DM.
• Primary outcomes included stroke and bleeding; secondary outcomes included vascular events and functional outcomes within 90 days.

Main Results:

• No significant difference in stroke risk reduction with immediate versus delayed statin therapy across glycemic subgroups.
• Immediate-intensive statin therapy reduced the risk of poor functional outcome in patients without T2DM (aRR 0.71, P=0.004).
• No functional outcome benefit was observed for patients with newly diagnosed or existing T2DM compared to delayed-intensive statin.

Conclusions:

• Patients without T2DM experienced greater functional outcome benefits from immediate-intensive statin therapy post-ischemic stroke.
• The efficacy of immediate-intensive statin therapy in improving functional outcomes after ischemic stroke may be dependent on glycemic status, specifically the absence of T2DM.