Use of Statins After Ischemic Stroke in Young Adults and Its Association With Long-Term Outcome.
Use of Statins After Ischemic Stroke in Young Adults and Its Association With Long-Term Outcome.
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DOI：
10.1161/strokeaha.119.026992
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发表时间：
2019-11
期刊：
影响因子：
8.3
通讯作者：
Myrna M E van Dongen;K. Aarnio;N. Martinez-Majander;J. Pirinen;J. Sinisalo;M. Lehto;M. Kaste;T. Tatlisumak;F. de Leeuw;J. Putaala
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文献类型：
--
作者：
Myrna M E van Dongen;K. Aarnio;N. Martinez-Majander;J. Pirinen;J. Sinisalo;M. Lehto;M. Kaste;T. Tatlisumak;F. de Leeuw;J. Putaala
背景和目的--对年轻人使用二级预防药物的认识是有限的.我们研究了他汀类药物的使用及其与年轻缺血性卒中患者（已知动脉粥样硬化负荷较低的患者组）随后血管事件的相关性。方法：研究人群包括1994年至2007年赫尔辛基Young卒中登记处的935例首次30天缺血性卒中幸存者，年龄15至49岁。截至2012年的随访数据来自芬兰社会保险机构（药物处方登记处）、芬兰护理登记处和芬兰统计局。通过校正的考克斯回归分析评估他汀类药物（定义为至少购买2次）的使用与全因死亡率、复发性卒中和其他复发性血管事件的相关性。我们进一步比较了倾向评分匹配的他汀类药物使用者与非使用者。结果-在我们的935例患者中，46.8%在随访期间的某个时间点使用他汀类药物。年龄较大、血脂异常、酗酒和高血压与购买他汀类药物显著相关。校正血脂异常、卒中亚型和其他混杂因素后，他汀类药物使用者的全因死亡率（风险比，0.38 [95%CI，0.25-0.58]）和卒中复发（风险比，0.29 [95%CI，0.19-0.44]）风险低于非使用者。在倾向评分匹配比较后，这些结果保持不变。结论：不到一半的年轻缺血性卒中患者使用他汀类药物;使用受年龄和危险因素的影响。他汀类药物的使用与全因死亡率和复发性卒中的风险降低独立相关。
Background and Purpose- Knowledge of the use of secondary preventive medication in young adults is limited. We studied the use of statins and its association with subsequent vascular events in young adults with ischemic stroke-a patient group with a known low burden of atherosclerosis. Methods- The study population included 935 first-ever 30-day ischemic stroke survivors aged 15 to 49 years from the Helsinki Young Stroke Registry, 1994 to 2007. Follow-up data until 2012 were obtained from the Social Insurance Institution of Finland (Drug Prescription Register), the Finnish Care Register, and Statistics Finland. The association of the use of statins (defined as at least 2 purchases) with all-cause mortality, recurrent stroke, and other recurrent vascular events was assessed through adjusted Cox regression analyses. We further compared propensity score-matched statin users with nonusers. Results- Of our 935 patients, 46.8% used statins at some point during follow-up. Higher age, dyslipidemia, heavy alcohol use, and hypertension were significantly associated with purchasing statins. Statin users exhibited lower risk of all-cause mortality (hazard ratio, 0.38 [95% CI, 0.25-0.58]) and recurrent stroke (hazard ratio, 0.29 [95% CI, 0.19-0.44]) than nonusers, after adjustment for dyslipidemia, stroke subtype, and other confounders. These results remained unchanged after propensity score-matched comparison. Conclusions- Less than half of young ischemic stroke patients used statins; use was affected by age and risk factor profile. Statin use was independently associated with lower risk of all-cause mortality and recurrent stroke.