This information is helpful in telling us that statins can reduce stroke risk after a stroke has occurred. How do stroke survivors and their carers use practitioners‘ advice on secondary prevention medications? Cardiovasc Res. doi:10.1212/WNL.0b013e31822f0423, 17. Notably, PAD, also an indication for statin use, was not associated with increased use of statins in the full model, though it was associated with increased probability of high intensity of statins. Trends in use of high-intensity statin therapy after myocardial infarction, 2011 to 2014. Fam Pract. 2017;26:201–207. Statins are effective in reducing the risk of ischaemic stroke (strokes causes by a blocked blood vessel) regardless of cholesterol level. Finally, this study was based on UK primary care data, which may be of limit applicability to other countries. doi:10.1002/pds.4148, 18. • Associations & Partners Unspecified stroke accounted for more than a half of stroke patients in the CPRD. Table 2 Factors associated with statin use and high-intensity statin use within 2 years after stroke. Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease. Bhatnagar P, Scarborough P, Smeeton NC, Allender S. The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review. The study was retrospective, meaning the researchers only used data from the patients’ medical histories, so the researchers cannot determine why some stroke patients stopped taking statins. Those who did not change initial intensity through 2 years accounted for 86.4%. • Top, © Copyright 2020 • Dove Press Ltd After a stroke, your doctor will likely give you a cholesterol-lowering medication called a statin. Stroke. Better understanding of why statins are not taken up as effectively after stroke (eg, through qualitative research) could guide future implementation strategies to improve uptake. [document on the internet]; 2017. This study examines how statin prescribing after stroke has changed over time between 2000 and 2014 in a large representative sample of the UK general population, and explores factors associated with both statin use and with high-intensity statin use. After a stroke, most survivors experience a degree of inflammation in the brain, analogous to swelling after an injury, such as the noticeably swollen lump after an injury to the arm or leg. “Discontinuation of statin treatment in patients with ischemic stroke should be strongly discouraged in any stage, acute or chronic, of stroke,” Lee said. Izuka NJ, Alexander MA, Balasooriya-Smeekens C, Mant J, De Simoni A. Characteristics of the stroke cohort by statin use are shown in Table 1. doi:10.1093/eurheartj/ehr158, 10. Patient-related characteristics associated with non-persistence with statin therapy in elderly patients following an ischemic stroke. Despite an increase over time in both statin use and high dose use, suboptimal statin treatment remains common in many patients with ischemic stroke. Statin use after stroke Statins were identified using British National Formulary codes 18 within 2 years after the index stroke (Table S2). Data resource profile: clinical practice research datalink (CPRD). Collins R, Armitage J, Parish S, Sleight P, Peto R. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Number 3099067. Smokers and obese patients likewise had significantly increased statin and high-intensity statin use. Available from: https://www.nice.org.uk/media/default/standards-and-indicators/qof-indicator-assessment-report.Pdf. 2017;7:e016814. Statins have potentially serious side effects, and there are instances in which they should not be taken. Stroke incidence and mortality trends in us communities, 1987 to 2011. Second, the use of statins among pre-stroke non-users increased from 20% to 60% between 2000 and 2006 (Figure 3). People with narrow arteries who take statins can cut their risk of heart attack or stroke in half. Vargas JI, Arrese M, Shah VH, Arab JP. 4) To evaluate possible impact of missing data on the results, we restricted the analysis to those with individual IMD. Asberg S, Henriksson KM, Farahmand B, et al. 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. In order to provide our website visitors and registered users with a service tailored to their individual preferences we use cookies to analyse visitor traffic and personalise content. doi:10.1056/NEJMoa061894, 9. Older patients (aged ≥75 years), younger patients (<45 years), patients with no prior statin treatment, dementia, underweight, or absence of cardiovascular factors (coronary heart disease, smoking, obesity, diabetes, hypertension, or transient ischemic attack) were less likely to use statins and less likely to receive a high-intensity statin.Conclusion: There has been an increase over time in both statin use and dose, but many patients with ischemic stroke continue to be under-treated. The analysis included 80,442 patients with a first stroke, among whom 26,339 had specified ischemic stroke codes (Figure 1). Ischemic stroke and secondary prevention in clinical practice: a cohort study of 14,529 patients in the swedish stroke register. These conditions were also associated with high-intensity statin use (final three columns in Table 2), from 8% to 58% higher than the relevant reference group in the full model. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the global burden of disease study 2010. Increasing statin use after ischemic stroke over time has been reported in other studies up until 2010, which focused on use at the time of hospital discharge.24–26 Another study using primary care data reported an increase in statin use within 1 year following stroke from 56% in 2003 to 71% in 2006.27 This study included hemorrhagic stroke, for which the statin use patterns are likely to be different. 2009;3:CD002091. London: Gov.Uk. 2010;41:397–401. 2013;22:661–670. Stroke. Table 3 Factors associated with different chances of using a statin after ischemic stroke, and a high-intensity statin if used. I have read the AHA/ASA Multimedia Materials Usage Policy and agree to the terms of use, Scientific Publications: Purposes-Processes, Journal of the American Heart Association, http://newsroom.heart.org/news/quitting-statins-after-stroke-may-raise-risk-of-another-stroke?preview=3cec, AHA/ASA Multimedia Materials Usage Policy, Quitting statins after stroke may raise risk of another stroke. Table 1 Characteristics of the stroke cohort by statin use after stroke. Further evidence in this regard is needed to help improve the secondary prevention of ischemic stroke. The American Heart Association is devoted to saving people from heart disease and stroke – the two leading causes of death in the world. All the statins which had ever been on the market in the UK were analyzed in this study, including atorvastatin, cerivastatin, … Chen PS, Cheng CL, Kao Yang YH, Li YH. 2011;1:e000269. The lower use in heart failure may reflect the negative trials of statins in patients specifically with heart failure, though this would not contraindicate their use after stroke.39–41 Patients with CLD were less likely to receive statins. 2017;34:612–620. Qualitative study of an online forum. We estimated average hazard ratios (HRs) for statin use during the 2-year follow-up using Cox proportional hazards models with robust standard errors that allow for intragroup correlation to account for possible clustering effects by general practice. 2013;2014(129):S1–S45. The increase in high-intensity use reflects more recent guidelines, where high-intensity statins have been explicitly recommended for atherosclerotic cardiovascular disease, including ischemic stroke.9–11 The availability of generic atorvastatin, whose patent expired in 2011, may have contributed to the increase in the use of high-intensity statins (however, this did not influence the cost to patients, as all UK prescriptions cost a standard charge, from which almost all stroke patients are exempt).
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