TY - JOUR
TI - Statin therapy and outcome after ischemic stroke: Systematic review and meta-analysis of observational studies and randomized trials
AU - Ní Chróinín, D.
AU - Asplund, K.
AU - Åsberg, S.
AU - Callaly, E.
AU - Cuadrado-Godia, E.
AU - Díez-Tejedor, E.
AU - Di Napoli, M.
AU - Engelter, S.T.
AU - Furie, K.L.
AU - Giannopoulos, S.
AU - Gotto, A.M.
AU - Hannon, N.
AU - Jonsson, F.
AU - Kapral, M.K.
AU - Martí-Fàbregas, J.
AU - Martínez-Sánchez, P.
AU - Milionis, H.J.
AU - Montaner, J.
AU - Muscari, A.
AU - Pikija, S.
AU - Probstfield, J.
AU - Rost, N.S.
AU - Thrift, A.G.
AU - Vemmos, K.
AU - Kelly, P.J.
JO - ISRN Stroke
PY - 2013
VL - 44
TODO - 2
SP - 448-456
PB - 
SN - 2090-9454
TODO - 10.1161/STROKEAHA.112.668277
TODO - 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
TODO - 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.
ER -