More evidence for statin acute stroke benefits
MedWire News: Patients who take statins before and during hospitalization for a stroke have an improved chance of being discharged home, rather than to a nursing facility, a large US study suggests.
"The data presented here add further evidence to argue that ischemic stroke patients should be treated with a statin at the time of stroke hospitalization, as in-hospital statin use appears to significantly improve not only poststroke survival but also discharge disposition," the researchers write in Neurology.
The study included 12,689 patients admitted with ischemic stroke to 17 North Californian hospitals over a 7-year period. The unadjusted in-hospital mortality rate was 5.5% among patients who used statins before and during hospitalization compared with 10.6% for statin nonusers.
Also, 56.5% of statin users versus 47.3% of statin nonusers were discharged home, rather than to a nursing facility.
Among patients taking a statin at the time of hospital admission, the in-hospital mortality rates were 22.3% for those who underwent statin withdrawal versus 5.3% for those who continued with the treatment. The corresponding rates of home discharge were 39.1% and 54.9%.
These associations persisted after Alexander Flint (Kaiser Permanente, Redwood City, California) and colleagues accounted for age, gender, race, medical comorbidities, and hospital center by volume. However, they did not have access to some important variables, such as stroke severity and subtype.
The team therefore conducted analyses that focused on the "local care environment," to shift the analysis away from the individual patients and reduce the possibility for confounding by factors such as stroke severity and individual care goals.
One, for example, examined the outcomes of patients in relation to the likelihood for statin treatment being given at each center. "Because patient assignment to specific hospital centers is related to geography rather than factors related to the patient's stroke, one can think of patients as being randomly exposed to practice pattern variation among providers," say Flint et al.
In this model, in-hospital continuation or initiation of a statin more than doubled the likelihood for discharge home, but the adverse effect of discontinuing a statin did not persist.
The team notes: "The principal use of lovastatin and simvastatin in our cohort adds to other data more specific to the beneficial effects of atorvastatin in ischemic stroke and thus suggests a statin class effect."
By Eleanor McDermid