title: Influence of statin therapy at time of stroke onset on functional outcome among patients with atrial fibrillation.
abstract: BACKGROUND
  Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF.
  
  
  METHODS
  We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated.
  
  
  RESULTS
  Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia.
  
  
  CONCLUSIONS
  Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation.
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA, United States. Electronic address: daraeko@bu.edu.
authors.forename: Darae
authors.initials: D
authors.lastname: Ko
authors.affiliation: Department of Clinical and Administrative Sciences, Notre Dame of Maryland School of Pharmacy, Baltimore, MD, United States.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Thigpen
authors.affiliation: Department of Neurology, Boston University School of Medicine, Boston, MA, United States.
authors.forename: James A
authors.initials: JA
authors.lastname: Otis
authors.affiliation: Department of Cardiology, Geisinger Health System, Danville, PA, United States.
authors.forename: Kristen
authors.initials: K
authors.lastname: Forster
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
authors.forename: Lori
authors.initials: L
authors.lastname: Henault
authors.affiliation: Department of Biostatistics, Boston University School Public Health, Boston, MA, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Quinn
authors.affiliation: Department of Biostatistics, Boston University School Public Health, Boston, MA, United States.
authors.forename: Yorghos
authors.initials: Y
authors.lastname: Tripodis
authors.affiliation: Department of Cardiology, Geisinger Health System, Danville, PA, United States.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Nita
authors.initials: N
authors.lastname: Limdi
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hylek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Atrial fibrillation; Hydroxymethylglutaryl-CoA reductase inhibitors; Risk factors; Stroke; Therapy