Background and purpose: In observational studies, patients under statin therapy at the time of stroke onset have lower likelihoods of mortality and poor functional outcome. This neuroprotective effect could be related to anti-inflammatory and antiplatelet actions of statins. Our objective was to evaluate early functional outcome in a cohort of ischemic stroke patients.
Design and Method: stroke patients were included in PROTEGE-ACV, a multidisciplinary secondary prevention program aimed to improve adherence to clinical practice guidelines. Vascular risk factor (VRF) profile and control, and statin treatment in the year before stroke were collected, and functionality one-month after discharge was evaluated using modified Rankin scale.
Results: 1981 ischemic stroke patients (20% TIA) were included between December 2006 and December 2015; mean age was 76±11 years with 57% females. Patients receiving statins (n 713, 38%) had a significant higher prevalence of hypertension, diabetes, dislipidemia, obesity, metabolic syndrome, coronary heart disease, peripheral artery disease, chronic renal failure and previous stroke. Both groups had similar blood pressure, and patients under statins had lower total cholesterol (182±42 vs 200±40 mg/dL, p 0.00001), LDL-c (106±36 vs 128±47, p 0.00001) with similar levels of HDL-c and triglycerides; these patients also had lower GFR (62±23 vs 67±31 mL/min, 0.0003) and higher fasting glucose levels (103±26 vs 99±21 mg/mL; p 0.0003). Predictors of bad outcome in the multivariate analysis adjusted by age and VRF are shown in the table.
Conclusion: Even though patients under statin treatment before stroke had higher prevalence of vascular diseases, they have better functional outcomes one-month after the event. In our cohort, previous statin use seems to have neuroprotective effect, which could be related to modulation of inflammatory response, platelet aggregation, fibrinolysis and nitric oxide production.