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.