Konstantinos Tziomalos, Vasilios Giampatzis, Stella D. Bouziana, Marianna Spanou, Athinodoros Pavlidis, Maria Papadopoulou, Chrysoula Boutari, Dimitra Magkou, Christos Savopoulos, Apostolos I. Hatzitolios
Abstract
Introduction: Previous studies suggested that prior treatment with statins is associated with improved outcome in patients with acute ischemic stroke. However, most studies were retrospective and none compared the effects of different statins on stroke severity and outcome. We aimed to evaluate the effects of prior treatment with statins on stroke severity, functional outcome and in-hospital mortality in patients with acute ischemic stroke and to compare the effects of different statins on these parameters. Material-methods: We prospectively studied 539 consecutive patients (41.2% males, mean age 78.9±6.6 years) who were admitted for acute ischemic stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) at admission. The outcome was assessed with the modified Rankin scale (mRS) at discharge. Dependency was defined as mRS at discharge between 2 and 5. Adverse outcome was defined as mRS at discharge≥2. Results: Overall, 154 patients (28.6%) were taking a statin before admission to the hospital. At admission, the NIHSS did not differ between patients who were taking a statin before admission and those who were not. Dependency and adverse outcome at discharge were less frequent in patients who were taking a statin before admission than in those who were not. In binary logistic regression analysis, independent predictors of adverse outcome were older age, history of stroke and higher NIHSS score at admission whereas prior treatment with statins was independently associated with a favorable outcome. When the type of statin was entered in the multivariate model, prior treatment with simvastatin was associated with a favorable outcome whereas prior treatment with other statins was not associated with the outcome of patients. In-hospital mortality did not differ between patients who were treated with a statin prior stroke and those who were not. Conclusions: Treatment with statins prior to stroke is associated with better functional outcome at discharge. Prior treatment with simvastatin appears to be more beneficial than prior treatment with atorvastatin or rosuvastatin.
Keywords: Statins, stroke, functional dependency, outcome, pleiotropic effects