Intensive Versus Moderate Statin Therapy Discontinuation in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Huai Wu Yuan; Ren Jie Ji; Ya Jie Lin; Han Feng Chen; Guo Ping Peng; Ben Yan Luo

doi:10.1016/j.clinthera.2018.10.003

Intensive Versus Moderate Statin Therapy Discontinuation in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Clin Ther. 2018 Dec;40(12):2041-2049. doi: 10.1016/j.clinthera.2018.10.003. Epub 2018 Nov 9.

Authors

Huai Wu Yuan¹, Ren Jie Ji¹, Ya Jie Lin¹, Han Feng Chen¹, Guo Ping Peng¹, Ben Yan Luo²

Affiliations

¹ Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
² Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, China. Electronic address: luobenyan@zju.edu.cn.

PMID: 30420288
DOI: 10.1016/j.clinthera.2018.10.003

Abstract

Purpose: The differences of discontinuation risk between intensive and mild-to-moderate statin therapy in patients with acute ischemic stroke is not clear. This study aimed to clarify whether intensive statin therapy resulted in a significant increase in discontinuation early after discharge.

Methods: This multicenter registry study enrolled consecutive hospitalized patients with ischemic stroke or transient ischemic attack. All the patients were prescribed statin therapy at discharge. Intensity of statin therapy was defined according to the 2013 American College of Cardiology/American Heart Association guideline on the treatment of blood cholesterol. A logistic regression model was used to analyze the association between statin therapy intensity and discontinuation.

Findings: This study included 505 patients, of whom 64 and 441 received intensive and moderate statin therapy, respectively (mean follow-up, approximately 6 months). The rates of discontinuation of intensive and moderate statin therapy were 31.3% and 10.7% (P < 0.001), respectively. Variables with significant differences between the intensive and moderate statin therapy groups were included in the adjusted logistic regression model. Intensive statin therapy significantly increased discontinuation risk by 273.0% (odds ratio = 3.730; 95% CI, 2.013-6.911; P < .001) compared with moderate statin therapy. The result was consistent in most subgroups, except for patients with National Institutes of Health Stroke Scale scores ≥4.

Implications: In stroke secondary prevention, intensive statin therapy may significantly increase the risk of early discontinuation compared with moderate statin therapy. Future clinical trials that involve a comparison between intensive and moderate statin therapy for stroke secondary prevention should address the differences in discontinuation between these 2 groups.

Keywords: ischemic stroke; secondary prevention; statin intensity; therapy discontinuation; transient ischemic attack.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Ischemia / drug therapy*
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Discharge
Registries
Secondary Prevention
Stroke / drug therapy*

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors