@article{2988559,
    title = "Statin therapy and outcome after ischemic stroke: Systematic review and meta-analysis of observational studies and randomized trials",
    author = "Ní Chróinín, D. and Asplund, K. and Åsberg, S. and Callaly, E. and Cuadrado-Godia, E. and Díez-Tejedor, E. and Di Napoli, M. and Engelter, S.T. and Furie, K.L. and Giannopoulos, S. and Gotto, A.M. and Hannon, N. and Jonsson, F. and Kapral, M.K. and Martí-Fàbregas, J. and Martínez-Sánchez, P. and Milionis, H.J. and Montaner, J. and Muscari, A. and Pikija, S. and Probstfield, J. and Rost, N.S. and Thrift, A.G. and Vemmos, K. and Kelly, P.J.",
    journal = "ISRN Stroke",
    year = "2013",
    volume = "44",
    number = "2",
    pages = "448-456",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.112.668277",
    keywords = "hydroxymethylglutaryl coenzyme A reductase inhibitor, blood clot lysis;  brain ischemia;  follow up;  human;  meta analysis;  mortality;  observational study;  priority journal;  randomized controlled trial (topic);  Rankin scale;  review;  survival;  systematic review;  treatment outcome, Brain Ischemia;  Humans;  Hydroxymethylglutaryl-CoA Reductase Inhibitors;  Randomized Controlled Trials as Topic;  Stroke;  Thrombolytic Therapy;  Treatment Outcome",
    abstract = "BACKGROUND AND PURPOSE - : Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS - : The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS - : The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSION - : In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed. © 2013 American Heart Association, Inc."
}