Key result
Prestroke statins use was associated with a significantly reduced risk of the composite outcome of death or major disability at 3 months (adjusted OR 0.31) in patients with AF-related ischemic stroke.
Why the study?
AF-related ischemic stroke causes severe disability and mortality, and statins may exert neuroprotective effects independent of LDL-C lowering; whether prestroke statin use reduces plasma Ox-LDL levels and improves outcomes was unknown.
Does prestroke statin use improve clinical outcomes and reduce oxidized LDL levels in patients with atrial fibrillation-related acute ischemic stroke?
Cohort (n=242)
Yes
Does prestroke statin use improve clinical outcomes and reduce oxidized LDL levels in patients with atrial fibrillation-related acute ischemic stroke?
Odds Ratio: 0.31 (95% CI 0.17–0.74)
Absolute Event Rate: 51.9% vs 74.3%
p-value: p=0.009
Prestroke statin use in patients with atrial fibrillation-related acute ischemic stroke is associated with reduced plasma Ox-LDL levels and improved 3-month clinical outcomes, including lower mortality and major disability.
May support prestroke statins in AF-related stroke; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). METHODS: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72 h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score ≥ 3), and composite outcome (death/major disability) at 3 months after AIS. RESULTS: One hundred thirty-six patients were in no prestroke statins use group, and 106 in prestroke statins use group. Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P < 0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval (CI), 0.99-1.12; P = 0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16-0.91; P = 0.031)], major disability (adjusted OR, 0.38; 95% CI, 0.15-0.99; P = 0.047), and composite outcome (adjusted OR, 0.31; 95% CI, 0.17-0.74; P = 0.009). CONCLUSIONS: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.
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He et al. (2019) conducted a cohort in Atrial fibrillation-related acute ischemic stroke (n=242). Prestroke statins use vs. No prestroke statins use was evaluated on Composite outcome of death or major disability at 3 months (OR 0.31, 95% CI 0.17-0.74, p=0.009). Prestroke statins use was associated with a significantly reduced risk of the composite outcome of death or major disability at 3 months (adjusted OR 0.31) in patients with AF-related ischemic stroke.
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