Discontinuation of statin therapy and clinical outcome after ischemic stroke.
OBJECTIVE
The majority of patients with previous ischemic stroke are expected to benefit significantly from long-term statin therapy. However, discontinuation of medication therapy frequently occurs in clinical practice. The aim of this study was to assess the impact of discontinued statin therapy on clinical outcome in patients discharged after an acute ischemic stroke.


METHODS
The study population included 631 consecutive stroke survivors (322 men and 309 women; mean+/-SD age, 70.2+/-7.6 years) without clinical evidence of coronary heart disease. All patients were discharged on statin therapy and were followed up for 12 months after the acute ischemic stroke.


RESULTS
Within 12 months from discharge, 246 patients (38.9%) discontinued statin therapy; the mean time from discharge to statin discontinuation was 48.6+/-54.9 days (median time, 30 days; interquartile range, 18 to 55 days). During follow-up, 116 patients died (1-year probability of death=0.18; 95% CI, 0.15 to 0.21). Multivariate analysis demonstrated that after adjustment for all confounders and interactions, statin therapy discontinuation (hazard ratio=2.78; 95% CI, 1.96 to 3.72; P=0.003) was an independent predictor of all-cause 1-year mortality.


CONCLUSIONS
A large number of patients discontinue their use of statins early after acute stroke. Moreover, patients discontinuing statins have a significantly increased mortality during the first year after the acute cerebrovascular event. These findings suggest that patient care should be improved during the transition from a hospital setting to outpatient primary care.
Colivicchi
Furio
F
Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy. furcol@rdn.it
Bassi
Andrea
A
Santini
Massimo
M
Caltagirone
Carlo
C
D000368:Aged; D000069059:Atorvastatin; D002545:Brain Ischemia / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*; D019821:Simvastatin / Q000008:administration & dosage / Q000009:adverse effects; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome / Q000401:mortality*
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin