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Statin treatment and outcomes after embolic stroke of undetermined source

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Abstract

The association of low-density lipoprotein cholesterol lowering with outcomes in embolic stroke of undetermined source (ESUS) patients is unclear. In these patients we aimed to assess the effect of statin on stroke recurrence, major adverse cardiovascular events (MACE) and death rates. Consecutive ESUS patients in the Athens Stroke Registry were prospectively followed-up to 10 years for stroke recurrence, MACE, and death. The Nelson–Aalen estimator was used to estimate the cumulative probability by statin allocation at discharge and cox-regression analyses to investigate whether statin at discharge was a predictor of outcomes. Among 264 ESUS patients who were discharged and followed for 4 years, 89 (33.7%) were treated with statin at discharge. Patients who were discharged on statin had lower rates of stroke recurrence (3.58 vs. 7.23/100 patient-years, HR: 0.48; 95% CI 0.26–0.90), MACE (4.98 vs. 9.89/100 patient-years, HR: 0.49; 95% CI 0.29–0.85), and death (3.93 vs. 8.21/100 patient-years, HR: 0.50; 95% CI: 0.28–0.89). In the multivariate analysis, statin treatment at discharge was an independent predictor of stroke recurrence (adjusted HR: 0.48; 95% CI 0.26–0.91), MACE (adjusted HR: 0.48; 95% CI 0.28–0.82), and death (adjusted HR: 0.50; 95% CI 0.27–0.93). Patients with ESUS discharged on statins have lower rates of stroke recurrence, MACE, and death compared to those not receiving statin therapy.

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

    Dimitrios Sagris, Kalliopi Perlepe, Ioannis Leventis, Konstantinos Makaritsis & George Ntaios

  2. Cardiovascular Prevention & Research Unit Clinic & Laboratory of Pathophysiology Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Stamatia Samara

  3. Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Efstathios Manios, Eleni Korompoki & Konstantinos Vemmos

  4. Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece

    Haralampos Milionis

Authors
  1. Dimitrios Sagris
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  2. Kalliopi Perlepe
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  3. Ioannis Leventis
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  4. Stamatia Samara
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  5. Efstathios Manios
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  6. Eleni Korompoki
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  7. Konstantinos Makaritsis
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  8. Haralampos Milionis
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  9. Konstantinos Vemmos
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  10. George Ntaios
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Contributions

DS: study concept, statistical analysis and interpretation, and preparation of manuscript. KP: data collection and critical revision of the manuscript. IL: statistical analysis and interpretation and critical revision of the manuscript. SS: critical revision of the manuscript. EM: data collection and critical revision of the manuscript. EK: data collection and critical revision of the manuscript. KM: data collection and critical revision of the manuscript. HM: critical revision of the manuscript. KV: data collection, statistical analysis and interpretation and critical revision of the manuscript. GN: study concept, statistical analysis and interpretation, critical revision of the manuscript, and study supervision.

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Correspondence to Dimitrios Sagris.

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Human and animal rights statement

The scientific use of the data collected in the Athens Stroke Registry was approved by the local Ethics Committee.

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Informed consent for the use of the clinical data of the included patients were received directly from the patients or patients' representative.

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Sagris, D., Perlepe, K., Leventis, I. et al. Statin treatment and outcomes after embolic stroke of undetermined source. Intern Emerg Med 16, 1261–1266 (2021). https://doi.org/10.1007/s11739-021-02743-7

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  • DOI: https://doi.org/10.1007/s11739-021-02743-7

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