title: Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use: A population-based study.
abstract: Background Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results Overall, 77% (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72% ( n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56% were women, and 21% were black. In adjusted analyses, the HLD/no-statins group showed 35% (adjusted hazard ratio (aHR) = 0.65, 95% CI: 0.46-0.92), 27% (aHR = 0.73, 95% CI: 0.59-0.90), and 17% (aHR = 0.83, 95% CI: 0.70-0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17% significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.
authors.affiliation: 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|2 Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas, USA.
authors.forename: Samrat
authors.initials: S
authors.lastname: Yeramaneni
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.affiliation: 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.affiliation: 4 Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.|5 Baptist Health Neuroscience Center, Miami, Florida, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: de Los Rios La Rosa
authors.affiliation: 6 Michael E. DeBakey VA Medical Center, and Department of Neurology, Baylor College of Medicine, Houston Texas, USA.
authors.forename: Sharyl
authors.initials: S
authors.lastname: Martini
authors.affiliation: 7 Department of Neurology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Mackey
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.affiliation: 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cerebral infarction; LDL; cholesterol; obesity; outcomes; survival