Statin Therapy for Secondary Prevention in Ischemic Stroke Patients With Cerebral Microbleeds.
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Prats-Sanchez Luis, Camps-Renom Pol, Nash Philip S, Wilson Duncan, Ambler Gareth, Best Jonathan G, Guasch-Jiménez Marina, Ramos-Pachón Anna, Martinez-Domeño Alejandro, Lambea-Gil Álvaro, Díaz Garbiñe Ezcurra, Guisado-Alonso Daniel, Du Houwei, Al-Shahi Salman Rustam, Jäger Hans Rolf, Lip Gregory Y, Ay Hakan, Jung Simon, Bornstein Natan M, Gattringer Thomas, Eppinger Sebastian, van Dam-Nolen Dianne H, Koga Masatoshi, Toyoda Kazunori, Fluri Felix, Phan Thanh G, Srikanth Velandai K, Heo Ji Hoe, Bae Hee-Joon, Kelly Peter J, Imaizumi Toshio, Staals Julie, Köhler Sebastian, Yakushiji Yusuke, Orken Dilek Necioglu, Smith Eric E, Wardlaw Joanna M, Chappell Francesca M, Makin Stephen D, Mas Jean-Louis, Calvet David, Bordet Régis, Chen Christopher P, Veltkamp Roland, Kandiah Nagaendran, Simister Robert J, De Leeuw Frank-Erik, Engelter Stefan T, Peters Nils, Soo Yannie O, Zietz Annaelle, Hendrikse Jeroen, Mess Werner H, Werring David J, Marti-Fabregas Joan, Microbleeds International Collaborative Network (MICON)
Аннотация
METHODS: We conducted a pooled analysis of individual patient data from the Microbleeds International Collaborative Network, comprising 32 hospital-based prospective studies fulfilling the following criteria: adult patients with IS or TIA, availability of appropriate baseline MRI for CMB quantification and distribution, registration of statin use after the index stroke, and collection of stroke event data during a follow-up period of ≥3 months. The primary endpoint was the occurrence of recurrent symptomatic stroke (IS or ICrH), while secondary endpoints included IS alone or ICrH alone. We calculated incidence rates and performed Cox regression analyses adjusting for age, sex, hypertension, atrial fibrillation, previous stroke, and use of antiplatelet or anticoagulant drugs to explore the association between statin use and stroke events during follow-up in patients with CMBs.
RESULTS: In total, 16,373 patients were included (mean age 70.5 ± 12.8 years; 42.5% female). Among them, 10,812 received statins at discharge, and 4,668 had 1 or more CMBs. The median follow-up duration was 1.34 years (interquartile range: 0.32-2.44). In patients with CMBs, statin users were compared with nonusers. Compared with nonusers, statin therapy was associated with a reduced risk of any stroke (incidence rate [IR] 53 vs 79 per 1,000 patient-years, adjusted hazard ratio [aHR] 0.68 [95% CI 0.56-0.84]), a reduced risk of IS (IR 39 vs 65 per 1,000 patient-years, aHR 0.65 [95% CI 0.51-0.82]), and no association with the risk of ICrH (IR 11 vs 16 per 1,000 patient-years, aHR 0.73 [95% CI 0.46-1.15]). The results in aHR remained consistent when considering anatomical distribution and high burden (≥5) of CMBs.
DISCUSSION: These observational data suggest that secondary stroke prevention with statins in patients with IS or TIA and CMBs is associated with a lower risk of any stroke or IS without an increased risk of ICrH.
CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with IS or TIA and CMBs, statins lower the risk of any stroke or IS without increasing the risk of ICrH.