Kasper Adelborg (Denmark)
Aarhus University Hospital Department of Clinical EpidemiologyAuthor Of 2 Presentations
STATIN TREATMENT INTENSITY AND RISK OF RECURRENT ISCHEMIC STROKE - A POPULATION-BASED COHORT STUDY
Abstract
Background and Aims
High-intensity statins are recommended as tertiary prevention after ischemic stroke, but evidence on different statin intensities and the risk of recurrence remains inconclusive. We examined the association between statin intensity and the risk of recurrent ischemic stroke.
Methods
In this Danish nationwide, population-based, new-user, active comparator cohort study, we used the Danish Stroke Registry to identify patients with a first-time ischemic stroke during 2004-2018. Patients who redeemed a statin prescription within 7 days after discharge were assigned to cohorts according to international guidelines on statin intensity. We used competing risk methods to compute 10-year risk differences (RDs) and Cox regression to compute adjusted hazard ratios (aHRs) of ischemic stroke recurrence and all-cause mortality, adjusting for age, sex, calendar period, stroke severity, and other risk factors.
Results
Low (n=305), moderate (n=29,325), and high (n=6,115) intensity statin users were followed for a median of 4.2 years. The risk of recurrence was largely similar among high-intensity users compared with moderate-intensity (RD: -0.3% [95% CI: -3.7; 3.0], aHR: 1.09 [95% CI: 0.95; 1.24]) and low-intensity users (RD: -2.8% [95% CI: -6.2; 0.6], aHR: 0.78 [95% CI: 0.56; 1.08]). The risk of all-cause mortality was lower among high-intensity users compared with low-intensity (RD: -21.8% [95% CI: -26.5; -17.0], aHR: 0.65 [95% CI: 0.53; 0.79]) and moderate-intensity users (RD: -12.4% [95% CI: -17.1; -7.6], aHR: 0.79 [95% CI: 0.71; 0.87]).
Conclusions
High-intensity statin use was not associated with a reduced risk of recurrent ischemic stroke. All-cause mortality was lowered in a possible dose-dependent manner.
STROKE RECURRENCE IN DENMARK: RISK AND MORTALITY
Abstract
Background and Aims
Background and aims: Knowledge on the risk and prognosis of stroke recurrence is limited. We examined risks of stroke recurrence and mortality after first and recurrent stroke.
Methods
Methods: Danish patients (≥18 years) with a first-time ischemic stroke (IS; n = 105,527) or intracerebral hemorrhage (ICH; n = 13,387) during 2004–2018 were identified from the Danish Stroke Registry and the Danish National Patient Registry. Using competing risk methods, we computed absolute risks, risk differences, and odds ratios of stroke recurrence separately for each stroke subtype and within patient subgroups. Mortality was assessed with the Kaplan-Meier estimator.
Results
Results: The 1-year and 10-year risks of recurrence were 4% and 13% for IS and 2% and 7% for ICH. For IS, the risk increased marginally with age and was higher for men than for women, for milder first-time stroke than for more severe, and for obese than for normal weight patients. Essen risk scores predicted recurrence in a dose-response manner. For ICH, risks were similar between sexes and did not increase with body mass index and Essen risk score. For IS, the 1-year and 10-year risks of mortality were 17% and 56% after first-time stroke and 22% and 69% after recurrent stroke; corresponding estimates for ICH were 37% and 69% after a first-time event and 41% and 82% after a recurrent event.
Conclusions
Conclusions: The risk of stroke recurrence was substantial, especially after IS, but the risk varied among subgroups. The risk of mortality was higher after a recurrent than first-time stroke.