Clinical effectiveness of statin therapy after ischemic stroke: Primary results from the statin therapeutic area of the patient-centered research into outcomes stroke patients prefer and effectiveness research (PROSPER) study

Emily C. O'Brien, Melissa A. Greiner, Ying Xian, Gregg C. Fonarow, DaiWai M. Olson, Lee H. Schwamm, Deepak L. Bhatt, Eric E. Smith, Lesley Maisch, Deidre Hannah, Brianna Lindholm, Eric D. Peterson, Michael J. Pencina, Adrian F. Hernandez

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Background - In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. Methods and Results - Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (P<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. Conclusion - In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization.

Original languageEnglish (US)
Pages (from-to)1404-1413
Number of pages10
JournalCirculation
Volume132
Issue number15
DOIs
StatePublished - Oct 13 2015

Keywords

  • hydroxymethylglutaryl-CoA reductase inhibitors
  • lipids
  • patient-centered outcomes research
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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