title: Statin treatment is associated with improved prognosis in patients with AF-related stroke.
abstract: OBJECTIVE
  The most recent ACC/AHA guidelines recommend high-intensity statin therapy in ischemic stroke patients of presumably atherosclerotic origin. On the contrary, there is no specific recommendation for the use of statin in patients with non-atherosclerotic stroke, e.g. strokes related to atrial fibrillation (AF). We investigated whether statin treatment in patients with AF-related stroke is associated with improved survival and reduced risk for stroke recurrence and future cardiovascular events.
  
  
  METHODS
  All consecutive patients registered in the Athens Stroke Registry with AF-related stroke and no history of coronary artery disease nor clinically manifest peripheral artery disease were included in the analysis and categorized in two groups depending on whether statin was prescribed at discharge. The primary outcome was overall mortality; the secondary outcomes were stroke recurrence and a composite cardiovascular endpoint comprising of recurrent stroke, myocardial infarction, aortic aneurysm rupture or sudden cardiac death during the 5-year follow-up.
  
  
  RESULTS
  Among 1602 stroke patients, 404 (25.2%) with AF-related stroke were included in the analysis, of whom 102 (25.2%) were discharged on statin. On multivariate Cox-proportional-hazards model, statin treatment was independently associated with a lower mortality (hazard-ratio (HR): 0.49, 95%CI:0.26-0.92) and lower risk for the composite cardiovascular endpoint during the median 22 months follow-up (HR: 0.44, 95%CI:0.22-0.88), but not with stroke recurrence (HR: 0.47, 95%CI:0.22-1.01, p: 0.053).
  
  
  CONCLUSIONS
  In this long-term registry of patients with AF-related stroke, statin treatment was associated with improved survival and reduced risk for future cardiovascular events.
authors.affiliation: Department of Medicine, University of Thessaly, Larissa, Greece. Electronic address: gntaios@med.uth.gr.
authors.forename: G
authors.initials: G
authors.lastname: Ntaios
authors.affiliation: Department of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papavasileiou
authors.affiliation: Department of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Makaritsis
authors.affiliation: Department of Medicine, University of Ioannina, Ioannina, Greece.
authors.forename: H
authors.initials: H
authors.lastname: Milionis
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Manios
authors.affiliation: Acute Stroke Unit, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: G Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Vemmos
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Atrial fibrillation; Mortality; Statin; Stroke recurrence