title: Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease.
abstract: OBJECTIVE
  The effect of a statin-based medical intervention on prevention of fatal and non-fatal stroke recurrence and the incidence of all-causes mortality have been explored previously in aging populations within the scope of clinical trials research. However, such evidence needs to be explored under conditions of routine clinical practice. The objective of this study was to determine whether statin therapy in patients with a first stroke episode reduces the incidence of 6-year recurrent fatal or non-fatal stroke and all-cause mortality in an aging Mediterranean population without known coronary heart disease followed in routine medical practice.
  
  
  METHODS
  A retrospective study was carried out using records on death, hospitalizations owing to stroke and history of statin therapy included in the Badalona Serveis Assistencials (BSA) database. The cohort studied consisted of consecutive patients covered by the BSA health provider plan with a first-ever acute stroke episode during January 2003 until December 2008, for whom there was available information covering the 6-year follow-up period. Recurrence rate (RR) and incidence rate (IR) of fatal/non-fatal stroke and all-causes mortality were computed. Association with statin therapy was assessed by means of calculation of relative risk (RR) and hazard ratio (HR) using multivariate logistic regression and Cox proportional hazards models controlling for confounding covariates.
  
  
  CONCLUSIONS
  The cohort comprised a series of 601 consecutive patients [57% men, 75·9 (12·4) years old (88% >60 years)]. Of these, 32% received statins, which were associated with lower fatal/non-fatal recurrent stroke RR; 7% vs. 18% [adjusted RR=0·32 (CI: 0·16-0·61), P=0·001] and lower IR; 16·78 vs. 45·22 events/year-1000 subjects [adjusted HR=0·35 (0·19-0·64), P=0·001]. Similarly, observed all-causes mortality was lower in the cohort receiving statins; 11% vs. 16% [adjusted RR=0·29 (CI: 0·08-1·12), P=0·072], and also mortality rate; 26·09 vs. 36·25 deaths/year-1000 subjects [adjusted HR=0·23 (0·08-0·67), P=0·007].
  
  
  CONCLUSIONS
  Statin therapy in patients with first-ever acute stroke lowers the risk of 6-year stroke recurrence and improves survival in an aging Mediterranean cohort. These results add additional evidence in routine clinical practice to the observed effects of statins in clinical trials.
authors: Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain. asicras@bsa.cat
authors: A
authors: A
authors: Sicras-Mainar
authors: A
authors: A
authors: Planas-Comes
authors: X
authors: X
authors: Frias-Garrido
authors: R
authors: R
authors: Navarro-Artieda
authors: M
authors: M
authors: de Salas-Cansado
authors: J
authors: J
authors: Rejas-Gutiérrez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D055502:Secondary Prevention; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D015996:Survival Rate; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors