Impact of statin therapy on stroke recurrence and cardiovascular mortality - meta-analysis

  • Teoh RJJ & al.
  • Ther Adv Neurol Disord
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In poststroke patients, statin therapy effectively reduced the risk for ischaemic stroke but increased the risk for haemorrhagic stroke.
  • Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or transient ischaemic attack (TIA).

Why this matters

  • Statins may reduce cardiovascular (CV) events and mortality in patients with coronary heart disease, but the findings on the use of statin in patients with acute or previous history of ischaemic stroke and intracerebral haemorrhage (ICH) are inconsistent.

Study design

  • 17 randomised controlled trials (RCTs; n=11,576) met eligibility criteria.
  • Primary outcome: ischaemic or haemorrhagic stroke.
  • Secondary outcome: myocardial infarction (MI) events, major adverse cardiovascular events (MACEs), CV and all-cause mortality.
  • Funding: The Ministry of Health and Welfare and others.

Key results

  • Statin therapy increased the risk for haemorrhagic stroke (risk ratio [RR], 1.42; 95% CI, 1.07-1.87; P=.01), but reduced the risk for ischaemic stroke (RR, 0.85; 95% CI, 0.75-0.95; P=.006) in patients after stroke and ICH.
  • Statin therapy was associated with reduced risk for:
    • MI (RR, 0.75; 95% CI, 0.64-0.87),
    • MACEs (RR, 0.80; 95% CI, 0.71-0.91),
    • CV mortality (RR, 0.83; 95% CI, 0.74-0.92) and
    • net composite endpoints (RR, 0.83; 95% CI, 0.79-0.88; P<.001 for all>
  • Statin did not show any significant effect on all-cause mortality (RR, 1.02; 95% CI, 0.89-1.18; P=.74).

Limitations

  • Meta-analysis not based on individual patient data.

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