Shin-Joe Yeh1, Sung-Chun Tang1, Li-Kai Tsai1, Chih-Hung Chen2, Shih-Pin Hsu3, Yu Sun4, Li-Ming Lien5, Cheng-Yu Wei6, Ta-Chang Lai7, Po-Lin Chen8, Chien-Chung Chen9, Pai-Hao Huang10, Ching-Huang Lin11, Chung-Hsiang Liu12, Huey-Juan Lin13, Chaur-Jong Hu14, Cheng-Li Lin15, Jiann-Shing Jeng1, Chung Y Hsu16. 1. Stroke Center and Department of Neurology, National Taiwan University Hospital. 2. Department of Neurology, National Cheng Kung University Hospital. 3. Department of Neurology, E-Da Hospital. 4. Department of Neurology, En Chu Kong Hospital. 5. Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital. 6. Department of Neurology, Show Chwan Memorial Hospital. 7. Department of Neurology, Cheng Hsin General Hospital. 8. Department of Neurology, Taichung Veterans General Hospital. 9. Department of Neurology, St. Martin De Porres Hospital. 10. Department of Neurology, Cathay General Hospital. 11. Department of Neurology, Kaohsiung Veterans General Hospital. 12. Department of Neurology, China Medical University Hospital. 13. Department of Neurology, Chi Mei Medical Center. 14. Department of Neurology, Taipei Medical University-Shuang Ho Hospital. 15. Graduate Institute of Biomedical Sciences, China Medical University and Hospital. 16. Graduate Institute of Clinical Medical Science, China Medical University and Hospital.
Abstract
AIM: Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with ischemic stroke. One major metabolic derangement of CKD is dyslipidemia, which can be managed by statins. This study aimed to investigate whether the association of statins with post-stroke outcomes would be affected by renal function. METHODS: We evaluated the association of statin therapy at discharge with 3-month outcomes according to the estimated glomerular filtration rate (eGFR) of 50,092 patients with acute ischemic stroke from the Taiwan Stroke Registry from August 2006 to May 2016. The outcomes were mortality, functional outcome as modified Rankin Scale (mRS), and recurrent ischemic stroke at 3 months after index stroke. RESULTS: Statin therapy at discharge was associated with lower risks of mortality (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.34 to 0.50) and unfavorable functional outcomes (mRS 3-5; aHR, 0.80; 95% CI, 0.76 to 0.84) in ischemic stroke patients. After stratification by eGFR, the lower risk of mortality associated with statins was limited to patients with an eGFR above 15 mL/min/1.73 m2. Using statins at discharge was correlated with a lower risk of unfavorable functional outcomes in patients with an eGFR of 60-89 mL/min/1.73 m2. Statin therapy in patients with an eGFR of 60-89 mL/min/1.73 m2 may be associated with a higher risk of recurrent ischemic stroke compared with nonusers (aHR, 1.29; 95% CI, 1.07 to 1.57). CONCLUSIONS: In patients with acute ischemic stroke, the associations of statins with mortality and functional outcomes was dependent on eGFR.
AIM: Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with ischemic stroke. One major metabolic derangement of CKD is dyslipidemia, which can be managed by statins. This study aimed to investigate whether the association of statins with post-stroke outcomes would be affected by renal function. METHODS: We evaluated the association of statin therapy at discharge with 3-month outcomes according to the estimated glomerular filtration rate (eGFR) of 50,092 patients with acute ischemic stroke from the Taiwan Stroke Registry from August 2006 to May 2016. The outcomes were mortality, functional outcome as modified Rankin Scale (mRS), and recurrent ischemic stroke at 3 months after index stroke. RESULTS: Statin therapy at discharge was associated with lower risks of mortality (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.34 to 0.50) and unfavorable functional outcomes (mRS 3-5; aHR, 0.80; 95% CI, 0.76 to 0.84) in ischemic strokepatients. After stratification by eGFR, the lower risk of mortality associated with statins was limited to patients with an eGFR above 15 mL/min/1.73 m2. Using statins at discharge was correlated with a lower risk of unfavorable functional outcomes in patients with an eGFR of 60-89 mL/min/1.73 m2. Statin therapy in patients with an eGFR of 60-89 mL/min/1.73 m2 may be associated with a higher risk of recurrent ischemic stroke compared with nonusers (aHR, 1.29; 95% CI, 1.07 to 1.57). CONCLUSIONS: In patients with acute ischemic stroke, the associations of statins with mortality and functional outcomes was dependent on eGFR.