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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Ní, Chróinín, D; Asplund, K; Åsberg, S; Callaly, E; Cuadrado-Godia, E; Díez-Tejedor, E; Di, Napoli, M; Engelter, ST; Furie, KL; Giannopoulos, S; Gotto, AM; Hannon, N; Jonsson, F; Kapral, MK; Martí-Fàbregas, J; Martínez-Sánchez, P; Milionis, HJ; Montaner, J; Muscari, A; Pikija, S; Probstfield, J; Rost, NS; Thrift, AG; Vemmos, K; Kelly, PJ.
Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials.
Stroke. 2013; 44(2): 448-56. Doi: 10.1161/STROKEAHA.112.668277
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Co-Autor*innen der Med Uni Graz

Pikija Slaven

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Abstract:

BACKGROUND AND PURPOSE: Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS: The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤ 72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS: The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSIONS: In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.

Find related publications in this database (using NLM MeSH Indexing)

Brain Ischemia - drug therapy, epidemiology, mortality

Humans - administration & dosage

Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage

Randomized Controlled Trials as Topic - methods, trends

Stroke - drug therapy, epidemiology, mortality

Thrombolytic Therapy - methods, trends

Treatment Outcome - administration & dosage

Find related publications in this database (Keywords)

cerebral infarction

ischemia

neuroprotective agents

outcomes assessment

stroke

therapy

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