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Post-stroke in-hospital statin therapy linked to better outcomes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Statin use before a stroke and during hospitalization is associated with a greater likelihood of being discharged home, while statin therapy withdrawal in hospital is associated with reduced likelihood of a good outcome, according to findings reported in the May 22 issue of Neurology.

“Statins are known to reduce the risk of further strokes, but the timing of when a statin should be started has been unclear,” said lead author Dr. Alexander C. Flint, with Kaiser Permanente in Redwood City, California, in a journal statement. “Our research suggests that people should be given statins while they are in the hospital.”

Dr. Flint and colleagues examined statin use in relation to discharge disposition among 12,689 patients hospitalized with ischemic stroke over a 7-year period in the Kaiser Permanente Northern California system.

On univariate analysis, the rate of discharge to home was 54.6% among stroke patients taking a statin before hospitalization compared to 50.0% among statin nonusers, the investigators found. This rate was 56.5% versus 47.3% for statin use before and during hospitalization compared to nonuse, but 39.1% when statins were withdrawn in hospital versus 54.9% with statin continuation.

Statin use before hospitalization compared to nonuse was associated with in-hospital mortality rates of 7.6% versus 8.6%, respectively. For statin use before and during hospitalization versus nonuse, corresponding rates were 5.5% versus 10.6%. Again, statin withdrawal in hospital was associated with poorer outcomes, with a mortality rate of 22.3% compared 5.3% for statin continuation, the report indicates.

On multivariate analysis to control for confounding factors such as patient age, comorbidities, and ethnicity, statin use remained strongly associated with better discharge outcomes, the authors report, and statin withdrawal with worse outcomes.

However, relatively few patients underwent statin withdrawal, so related outcomes are less certain, Dr. Flint and colleagues caution.

Overall, they conclude, “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.”

SOURCE:

Neurology 2012;78:1678–1683.