title: Statin treatment and functional outcome after ischemic stroke: case-control and meta-analysis.
abstract: OBJECTIVE
  Multiple studies suggest that statin use before acute ischemic stroke is associated with improved functional outcome. However, available evidence is conflicting, and several published reports are limited by small sample sizes. We therefore investigated the effect of antecedent use of statins on stroke outcome by performing a meta-analysis of all results from published studies as well as our own unpublished data.
  
  
  METHODS
  We performed a systematic literature search and meta-analysis of studies investigating the association between prestroke statin use and clinical outcome and included additional data from 126 prestroke statin users and 767 nonusers enrolled at our institution. A total of 12 studies, comprising 2013 statin users and 9682 nonusers, was meta-analyzed using a random effects model. We also meta-analyzed results for individual Trial of ORG 10172 in Acute Stroke Treatment stroke subtypes to determine whether the effect of statin use differed across subtypes using the Breslow-Day test.
  
  
  RESULTS
  Meta-analysis of all available data identified an association between prestroke statin use and improved functional outcome (OR, 1.62; 95% CI, 1.39 to 1.88), but we uncovered evidence of publication bias. The effect of statin use on functional outcome was found to be larger for small vessel strokes compared with other subtypes (Breslow-Day P=0.008).
  
  
  CONCLUSIONS
  Antecedent use of statins is associated with improved outcome in patients with acute ischemic stroke. This association appears to be stronger in patients with small vessel stroke subtype. However, evidence of publication bias in the existing literature suggests these findings should be interpreted with caution.
authors.affiliation: J. Philip Kistler Stroke Research Center, Center for Human Genetics Research, Department of Neurology, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston MA 02114, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Biffi
authors.forename: William J
authors.initials: WJ
authors.lastname: Devan
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.forename: Lynelle
authors.initials: L
authors.lastname: Cortellini
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors