Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview.

Details

Serval ID
serval:BIB_299E15BF0C24
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview.
Journal
International journal of stroke
Author(s)
Milionis H., Ntaios G., Korompoki E., Vemmos K., Michel P.
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
Published
Issued date
07/09/2019
Peer-reviewed
Oui
Pages
1747493019873594
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents.
English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots.
Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60-0.82; p < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70-0.90; p < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of "the lower the better" hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals.
Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.
Keywords
Cholesterol, ischemic stroke, lipid lowering, meta-analysis, prevention, statin
Pubmed
Web of science
Create date
17/09/2019 16:47
Last modification date
09/12/2020 6:26
Usage data