Influence of Statin Pretreatment on Initial Neurological Severity and Short-Term Functional Outcome in Acute Ischemic Stroke Patients: The Fukuoka Stroke Registry.

Abstract

BACKGROUND:

Statins have neuroprotective effects against ischemic stroke. However, associations between pre-stroke statin treatment and initial stroke severity and between the treatment and functional outcome remain controversial. This study aimed at determining these associations in ischemic stroke patients.

METHODS:

Among patients registered in the Fukuoka Stroke Registry from June 2007 to October 2014, 3,848 patients with ischemic stroke within 24 h of onset, who had been functionally independent before onset, were enrolled in this study. Ischemic stroke was classified as cardioembolic or non-cardioembolic infarction. Primary and secondary study outcomes were mild neurological symptoms defined as a National Institutes of Health Stroke Scale score of ≤4 on admission and favorable functional outcome defined as a modified Rankin Scale score of ≤2 at discharge, respectively. Multivariable logistic regression models were used to quantify associations between pre-stroke statin treatment and study outcomes.

RESULTS:

Of all 3,848 participants, 697 (18.1%) were taking statins prior to the stroke. The frequency of mild neurological symptoms was significantly higher in patients with pre-stroke statin treatment (64.1%) than in those without the treatment (58.3%, p < 0.01). Multivariable analysis showed that pre-stroke statin treatment was significantly associated with mild neurological symptoms (OR 1.31; 95% CI 1.04-1.65; p < 0.01). Sensitivity analysis in patients with dyslipidemia (n = 1,998) also showed the same trend between pre-stroke statin treatment and mild neurological symptoms (multivariable-adjusted OR 1.26; 95% CI 0.99-1.62; p = 0.06). In contrast, the frequency of favorable functional outcome was not different between patients with (67.0%) and without (65.3%) the treatment (p = 0.40). Multivariable analysis also showed no significant association between pre-stroke statin treatment and favorable functional outcome (OR 1.21; 95% CI 0.91-1.60; p = 0.19). Continuation of statin treatment, however, was significantly associated with favorable functional outcome among patients with pre-stroke statin treatment (multivariable-adjusted OR 2.17; 95% CI 1.16-4.00; p = 0.02).

CONCLUSIONS:

Pre-stroke statin treatment in ischemic stroke patients was significantly associated with mild neurological symptoms within 24 h of onset. Pre-stroke statin treatment per se did not significantly influence the short-term functional outcome; however, continuation of statin treatment during the acute stage of stroke seems to relate with favorable functional outcome for patients with pre-stroke statin treatment.

• Authors: Hiromi Ishikawa, Yoshinobu Wakisaka, Ryu Matsuo, Noriko Makihara, Jun Hata, Junya Kuroda, Tetsuro Ago, Jiro Kitayama, Hiroshi Nakane, Masahiro Kamouchi, Takanari Kitazono, Fukuoka Stroke Registry Investigators
• Journal: Cerebrovascular diseases (Basel, Switzerland) (Cerebrovasc Dis) Vol. 42 Issue 5-6 Pg. 395-403 ( 2016) ISSN: 1421-9786 [Electronic] Switzerland
• PMID: 27376661 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2016 S. Karger AG, Basel.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Neuroprotective Agents

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (complications, diagnosis, physiopathology, rehabilitation)
• Chi-Square Distribution
• Disability Evaluation
• Dyslipidemias (complications, diagnosis, drug therapy)
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Japan
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Neurologic Examination
• Neuroprotective Agents (therapeutic use)
• Odds Ratio
• Protective Factors
• Registries
• Risk Factors
• Severity of Illness Index
• Stroke (complications, diagnosis, physiopathology, therapy)
• Stroke Rehabilitation
• Time Factors
• Treatment Outcome