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Sico JJ, Ofner S, Baye F, Concato J, Zillich AJ, Reeves M, Cheng E, Phipps MS, Arling G, Johanning J, Chaturvedi S, Williams LS, Bravata DM. Intensification of Statin Treatment is Associated with Improved Mortality Among Patients with TIA and Ischemic Stroke. Poster session presented at: American Heart Association / American Stroke Association International Stroke Conference; 2016 Feb 18; Los Angeles, CA.
Introduction: Current guidelines for hyperlipidemia among patients with cerebrovascular disease recommend prescribing moderate/high potency statins rather than intensifying (low/moderate) treatment, but whether this treatment approach confers mortality benefits is unclear. Hypothesis: Intensification of statin therapy will be associated with improved outcomes within a given potency strata. Methods: Administrative data were analyzed from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a TIA or ischemic stroke in fiscal year 2011. Patients who: were transferred to another non-VHA acute care facility or hospice, died in the emergency room/hospital, left against medical advice, had a documented statin allergy were excluded (n = 1538). Treatment intensification was defined as an increase in potency class within 7-days of discharge. Multivariable logistic regression models were used to determine whether treatment intensification (vs. none) was associated with differences in 30-day and 1-year mortality. Results: Among 9,768 eligible patients, 66.5 % (n = 6494) were prescribed statins at discharge; a majority (90.4%) were prescribed moderate/high potency statins. Treatment intensification occurred among 51.7% and 57.1% of patients in the moderate/high potency and low potency strata, respectively. Compared with patients receiving moderate/high potency statins without intensification, intensification was associated with lower 1-year (odds ratio [OR] = 0.51; confidence Interval [CI]95:0.33, 0.80) but not 30-day (OR = 2.10; CI95:0.66, 6.68) mortality. Compared with patients receiving low potency statins without intensification, intensification was associated with lower 1-year (OR = 0.79 CI95:0.67, 0.93) and thirty-day (OR = 0.72; CI95:0.52, 0.99) mortality. Conclusion: Treatment intensification for patients receiving moderate/high or low potency statins was associated with improved mortality after a cerebrovascular event, with potential implications for future treatment guidelines.
