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Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke

Authors
 Jinkwon Kim  ;  Hye Sun Lee  ;  Chung Mo Nam  ;  Ji Hoe Heo 
Citation
 Stroke, Vol.48(10) : 2723-2730, 2017 
Journal Title
 Stroke 
ISSN
 0039-2499 
Issue Date
2017
MeSH
Aged ; Brain Ischemia/diagnosis* ; Brain Ischemia/drug therapy* ; Brain Ischemia/epidemiology ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Insurance Claim Review/trends ; Male ; Medication Adherence* ; Middle Aged ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Stroke/diagnosis* ; Stroke/drug therapy* ; Stroke/epidemiology ; Time Factors ; Treatment Outcome
Keywords
Republic of Korea ; insurance, health ; prognosis ; regression analysis ; secondary prevention
Abstract
BACKGROUND AND PURPOSE: Statin is an established treatment for secondary prevention after ischemic stroke. However, the effects of statin intensity and adherence on the long-term prognosis after acute stroke are not well known. METHODS: This retrospective cohort study using a nationwide health insurance claim data in South Korea included patients admitted with acute ischemic stroke between 2002 and 2012. Statin adherence and intensity were determined from the prescription data for a period of 1 year after the index stroke. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. We performed multivariate Cox proportional regression analyses. RESULTS: We included 8001 patients with acute ischemic stroke. During the mean follow-up period of 4.69±2.72 years, 2284 patients developed a primary outcome. Compared with patients with no statin, adjusted hazard ratios (95% confidence interval) were 0.74 (0.64-0.84) for good adherence, 0.93 (0.79-1.09) for intermediate adherence, and 1.07 (0.95-1.20) for poor adherence to statin. Among the 1712 patients with good adherence, risk of adverse events was lower in patients with high-intensity statin (adjusted hazard ratio [95% confidence interval], 0.48 [0.24-0.96]) compared with those with low-intensity statin. Neither good adherence nor high intensity of statin was associated with an increased risk of hemorrhagic stroke. CONCLUSIONS: After acute ischemic stroke, high-intensity statin therapy with good adherence was significantly associated with a lower risk of adverse events.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/160913
DOI
10.1161/STROKEAHA.117.018140
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
Yonsei Authors
남정모(Nam, Jung Mo) ; 이혜선(Lee, Hye Sun) ; 허지회(Heo, Ji Hoe)
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Full Text
http://stroke.ahajournals.org/content/48/10/2723.long
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