title: Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study.
abstract: BACKGROUND
  In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making.
  
  
  RESULTS
  Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (P<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin.
  
  
  CONCLUSIONS
  In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization.
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution. emily.obrien@duke.edu.
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Lesley
authors.initials: L
authors.lastname: Maisch
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Deidre
authors.initials: D
authors.lastname: Hannah
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Brianna
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008499:Medical Records / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: hydroxymethylglutaryl-CoA reductase inhibitors; lipids; patient-centered outcomes research; stroke