AHA 2015: Statin therapy benefits ischemic stroke patients in real-world settings

November 9, 2015 – Recent results from the PROSPER study show that statin therapy is linked to better outcomes for older ischemic stroke patients.

Statin therapy is associated with a lower risk of major adverse cardiovascular events (MACE) and more home time for older ischemic stroke patients, according to the latest findings from the Patient-centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study.

The results of the study were presented Monday at the annual Scientific Sessions of the American Heart Association in Orlando, Florida. The results were previously published in the journal Circulation.

emily-obrien-newsCurrent guidelines recommend statin use for patients who have experienced a stroke due to atherosclerosis. However, the data supporting those guidelines come largely from studies composed of patients who are younger and healthier than most stroke patients. Moreover, there is little data on the optimal dose and intensity of statin therapy.

“Clinical trials often define their study populations rather narrowly,” said the DCRI’s Emily O’Brien, PhD, the study’s lead author. “We wanted to see the real-world effectiveness of this therapy in a nationally representative population.”

For patients, the benefits and risks of statin therapy are not always recognized by clinicians and researchers. “Home time,” or the amount of time spent alive and out of the hospital, has been identified as a particularly meaningful outcome for stroke patients. However, relatively little research has been devoted to this topic.

To address these questions, DCRI researchers used data from the Get With the Guidelines-Stroke registry paired with Medicare claims to identify ischemic stroke patients aged 65 years or older who were discharged alive from the hospital between 2007 and 2011. They then analyzed data on outcomes for two years after discharge, including MACE, home-time days, all-cause mortality, all-cause readmission, ischemic stroke readmission, hemorrhagic stroke readmission, and cardiovascular readmission.

The researchers also compared the effect of statins on certain subgroups, including patients 65 to 80 years of age versus older than 80 years; male versus female patients; white versus nonwhite patients; patients with low cholesterol versus high cholesterol; low National Institutes of Health Stroke Scale (NIHSS) score versus high NIHSS score; and patients with previous heart attack or coronary artery disease versus those without.

Of 77,468 ischemic stroke patients who were not taking statins at the time of admission and were discharged alive, 54,991 (71.0 percent) were prescribed statin therapy at discharge.
The researchers found that discharge statin therapy was associated with a lower risk of MACE and lower mortality for up to two years after experiencing an ischemic stroke. Patients discharged on statins also had, on average, 28 more days at home compared with those not discharged on statins.

Compared with low or moderate-intensity statin therapy, high-intensity statin therapy was not associated with better clinical outcomes or more days at home after discharge. These benefits were observed across each of the subgroups the researchers studied.

In addition to O’Brien, the study’s other Duke authors included Melissa A. Greiner, MS; Ying Xian, MD, PhD; Eric D. Peterson, MD, MPH; Michael J. Pencina, PhD; and Adrian F. Hernandez, MD, MHS.