Stat Methods Med Res. Data resource profile: clinical practice research datalink (CPRD). Vargas JI, Arrese M, Shah VH, Arab JP. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Int J Clin Pharm. 2005;36:1771–1775. Key data on the benefits of statins after ischemic stroke were published between 2000 and 2006.7,8 Afterward, the proportion of stroke patients on statins was stable at 70–75% during the period that targets were in place for UK family doctors. Chen PS, Cheng CL, Kao Yang YH, Li YH. The quality of inpatient therapy is unparalleled to other options. Finally, this study was based on UK primary care data, which may be of limit applicability to other countries. doi:10.1093/fampra/cmx023. This puffiness, called edema, is part of the body’s repair mechanism. From editorial acceptance to publication. It seems that this is more than just reducing … Eur Heart J. English Indices of Deprivation. The American Heart Association recommends intensive statin therapy for patients who have had an ischemic stroke or TIA and who have an LDL-cholesterol level of more than 100 mg/dL, but does not recommend stopping statins based on achieving a specific LDL-cholesterol level in most people depending on individual risk. doi:10.1001/jama.283.24.3230, 37. Ethics approval was obtained from the Independent Scientific Advisory Committee of the CPRD (protocol number 17_012R), with no written consent from participants required. Rosenson RS, Farkouh ME, Mefford M, et al. Follow us on Facebook and Twitter. Reiner Z, Catapano AL, De Backer G, et al. The drugs known as statins do many good things. 2007;357:2248–2261. ; 2015. Statin uptake after stroke is also influenced by a variety of pre-stroke cardiovascular comorbidities and LLT. Restricting analysis to statin users who completed 2-year follow-up after stroke, we used modified Poisson regression with robust standard error to explore possible factors for high-intensity statin treatment.22 Risk ratios (RRs) were calculated in an unadjusted model, in a partial adjustment model, and in a full model. Extension of the modified poisson regression model to prospective studies with correlated binary data. Circulation. Accessed November 16, 2018. The study benefits from the strengths of the CPRD in terms of representativeness of real practice settings, detailed prescription information, large sample size, long-term temporal coverage, and sufficient follow-up duration.18, Several limitations of this study should be acknowledged. Unspecified stroke accounted for more than a half of stroke patients in the CPRD. Researchers also found that discontinuing statin drugs, which lower cholesterol, between three and six months after a first ischemic stroke was linked to higher risk of death and hospitalization among the patients in the study. Register your specific details and specific drugs of interest and we will match the information you provide to articles from our extensive database and email PDF copies to you promptly. We had incomplete data regarding the stroke subtypes. By accessing the work you hereby accept the Terms. High-dose atorvastatin after stroke or transient ischemic attack. Treating nondementia illnesses in patients with dementia. Patients with any statin prescriptions during the 365 days prior to their index stroke were regarded as pre-stroke statin users, with the intensity defined as highest intensity they ever used in this period. Quality control was performed before analysis (Table S3). Statin usage was similar across all socioeconomic groups and between genders after adjustment. Catapano AL, Graham I, De Backer G, et al. Open access peer-reviewed scientific and medical journals. Now, studies have shown that statins can reduce the risk of recurrent stroke by as much as 30-40%. Dregan A, Toschke MA, Wolfe CD, et al. doi:10.1016/S1474-4422(06)70351-9, 45. Patients with any Read codes relating to hemorrhagic stroke for the index stroke were excluded. Dove Medical Press is a member of the OAI. Several features of ; Yi-Ling Wu, M.S. Recent studies focusing on CHD suggested that 35% of patients started high-intensity statins after hospital discharge between 2007 and 2009 and the proportion increased from 33.5% in 2011 to 71.7% in 2014.28,29 By comparison, statin usage after ischemic stroke in our study is substantially lower. 2009;3:CD002091. 2009;6:712–722. Stroke Association, UK. This may be justified in older people if a palliative approach is being taken, or reflect concern that the key statin trials in a post-stroke population had mean ages of participants of about 65 years;7,8 underuse may also reflect concerns about the potential increased risk of adverse effects in the presence of multiple comorbidities and polypharmacy.35 The underuse of statins in patients with dementia may indicate lack of data on risks and benefits of statins in these patients, who may have reduced ability to adhere to treatment, decreased capacity to experience benefits and increased risk of adverse effects.36 The absence of other cardiovascular comorbidities such as diabetes, hypertension, and CKD was consistently associated with lower probability of statin use and high-intensity statin use after stroke, which differs from studies of CHD and PAD populations.28,29,37 This, together with the strong association of statin use (positive association) and other LLT use (inverse association) prior to stroke with post-stroke statin use, suggests that the occurrence of a stroke does not have the impact on statin use that would be expected from the guidelines,9–11 and that patients who are new users or who require increased statin doses after stroke may benefit from increased support to overcome clinical inertia.38 Paradoxically, patients with CHD, PAD, TIA, or diabetes who were not taking a statin before their stroke were less likely than other patients to initiate a statin after stroke; this may indicate that prior appropriate contraindications to a statin persisted, or that clinical inertia in a high-risk group was not being addressed.