Glycemic Status and Effect of Immediate Intensive Statin on Mild Ischemic Stroke: A Subgroup Analysis of the INSPIRES Trial.

AIMS: A subgroup analysis of the Intensive Statin and Antiplatelet Therapy for High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial to evaluate intensive statin effects in patients with ischemic stroke by glycemic status.

METHOD: Patients were stratified into three subgroups based on glycemic status: without type 2 diabetes mellitus (T2DM), with newly diagnosed T2DM, with a history of T2DM. The primary outcomes included stroke and moderate-to-severe bleeding, whereas secondary outcomes comprised composite vascular events, poor functional outcomes, and any bleeding within 90 days.

RESULTS

Among 6100 patients, 4038 were without T2DM, 404 had a newly diagnosed T2DM, and 1658 had a history of T2DM. No significant risk reduction of stroke was observed with immediate versus delayed statin therapies across glycemic subgroups (p for interaction = 0.29). Compared to delayed-intensive statin, immediate-intensive statin treatment was associated with reduced risk of poor functional outcome in non-T2DM patients (adjusted relative risk 0.71, 95% CI 0.57-0.90; p = 0.004), but no benefit in those with newly diagnosed T2DM or those with a history of T2DM (p for interaction = 0.003). There was no glycemic status by treatment interaction for risk of bleeding or composite vascular event.

CONCLUSIONS

Patients without T2DM derived greater benefit in functional outcomes from immediate-intensive statin after ischemic stroke than those with T2DM.