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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.