Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2015-10, Vol.132 (15), p.1404-1413
• Main Authors: O’Brien, Emily C, Greiner, Melissa A, Xian, Ying, Fonarow, Gregg C, Olson, DaiWai M, Schwamm, Lee H, Bhatt, Deepak L, Smith, Eric E, Maisch, Lesley, Hannah, Deidre, Lindholm, Brianna, Peterson, Eric D, Pencina, Michael J, Hernandez, Adrian F
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Brain Ischemia - prevention & control; Cardiovascular Diseases - prevention & control; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Hospitalization - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Medicaid - statistics & numerical data; Medical Records - statistics & numerical data; Medicare - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient Outcome Assessment; Patient Readmission - statistics & numerical data; Recurrence; Registries - statistics & numerical data; Treatment Outcome; United States
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.115.016183

BACKGROUND—In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. METHODS AND RESULTS—Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute–funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines–Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87–0.94), 28 more home-time days after discharge (P