High-intensity statins confer reduced clinical, cerebral events in AF, stroke
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High-intensity statins may reduce adverse clinical and/or cerebral events in patients with acute ischemic stroke and atrial fibrillation, with particularly strong efficacy in patients who underwent revascularization and are younger than 75 years, according to findings published in the Journal of the American Heart Association.
Researchers found that patients with acute ischemic stroke and AF receiving low- to moderate-intensity statins (adjusted HR = 0.64; 95% CI, 0.52-0.78) and high-intensity statins (HR = 0.51; 95% CI, 0.4-0.66) experienced fewer net adverse clinical and cerebral events, including death from any cause, stroke, ACS or major bleeding, than those who did not receive any statin therapy.
Moreover, high-intensity statins were associated with a lower risk for net adverse clinical and cerebral events than low- to moderate-intensity statins (HR = 0.76; 95% CI, 0.59-0.96) in this population, according to the study.
“Our findings suggest that statin therapy, particularly high-intensity statin therapy, could be associated with a reduced risk for adverse events, reduced mortality rates and increased probability of favorable functional outcomes compared with no-statin therapy in patients with acute ischemic stroke and AF,” Kang-Ho Choi, MD, PhD, of the department of neurology at the Chonnam National University Hwasun Hospital, South Korea, and colleagues wrote. “These benefits of statin therapy were consistent across various subgroups of patients, including those who are older patients, had low baseline LDL levels, receiving anticoagulant treatment and without clinical atherosclerotic CVD.”
Statin intensity by subgroup
The benefit of high-intensity statins compared with low- to moderate-intensity statins was greatest for patients treated with revascularization therapy (HR = 0.52; 95% CI, 0.32-0.84; P for interaction = .042) and in patients aged 75 years or younger (HR = 0.57; 95% CI, 0.39-0.86; P for interaction = .044), according to the researchers.
Study design and looking forward
Researchers enrolled 2,153 patients (mean age, 73 years; 52% men; 69.9% with hypertension; 27.4% with diabetes) with acute ischemic stroke and AF into this nationwide, multicenter cohort study. The primary composite endpoint was occurrence of adverse clinical and/or cerebral events during a 3-year period, and participants were stratified by statin intensity.
“Our results support the beneficial effect of statins, particularly high-intensity statins, in patients with acute ischemic stroke and AF, including the subgroup of patients who may be vulnerable to statin therapy and those without clinical ASCVD,” the researchers wrote. “These findings require further investigation and confirmation in prospective randomized controlled trials.” – by Scott Buzby
Disclosures: One author reports he received honoraria for lectures from Bayer, Boryung Pharmaceutical, Daewoong Pharmaceutical Co. Ltd., Daiichi Sankyo Korea Co. Ltd., Dong-A Pharmaceutical Co. Ltd., Otsuka Korea, Pfizer and Sanofi Aventis; study grants from Daiichi Sankyo Korea Co. Ltd.; and a consultant fee from OBELAB Inc.
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