Statin use and sex-specific stroke outcomes in patients with vascular disease.
OBJECTIVE
Although statins reduce the risk of stroke in patients with coronary heart disease, possible differing effects of statins on stroke outcomes based on sex remain uncertain. We investigated the relationships between statin use and sex-specific stroke incidence, severity, and mortality.


METHODS
Data from 3 trials of oral glycoprotein IIb/IIIa inhibitors (first and second Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes [SYMPHONY] and Blockade of the glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion [BRAVO]) were pooled and stroke outcomes compared among 8191 baseline statin users versus 14,752 nonusers. Time-to-event data were modeled with proportional hazards regression. Stroke severity was assessed retrospectively with the Canadian Neurological Scale (CNS) based on records with scoreable neurological examinations.


RESULTS
A total of 217 subjects had strokes (0.95%). Statin users had a lower risk of stroke in unadjusted (hazard ratio [HR], 0.69; 95% CI, 0.51 to 0.92) and risk-adjusted models (HR, 0.72; 95% CI, 0.53 to 0.97). There was no difference in stroke mortality with statin use (P=0.8). CNS scores could be assigned to 106 of the subjects, with no difference in severity among statin users and nonusers (median CNS=10.5 in users versus CNS=9.75 in nonusers; P=0.14). Women had more severe strokes than men (median CNS=10.5 in men versus 9.5 in women; Poisson regression P=0.035). Women had more severe strokes after adjustment for statin use (P=0.03) and the combination of statin use, atrial fibrillation, and age (P=0.03).


CONCLUSIONS
In patients included in these clinical trials of oral glycoprotein IIb/IIIa inhibitors, statin use is associated with a reduced risk of stroke but not severity or mortality. Women had more severe strokes than men, a difference that was not explained by baseline characteristics or statin use.
Bushnell
Cheryl D
CD
Center for Cerebrovascular Disease, Duke University Medical Center, Durham, NC 27710, USA. Cheryl.bushnell@duke.edu
Griffin
Jeffrey
J
Newby
L Kristin
LK
Goldstein
Larry B
LB
Mahaffey
Kenneth W
KW
Graffagnino
Carmelo A
CA
Harrington
Robert A
RA
White
Harvey D
HD
Simes
R John
RJ
Califf
Robert M
RM
Topol
Eric J
EJ
Easton
J Donald
JD
D000368:Aged; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D012727:Sex Characteristics; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000517:prevention & control*; D014652:Vascular Diseases / Q000150:complications* / Q000188:drug therapy*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex