Health Services Research & Development

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Sico J, Hu X, Ofner S, Baye F, Dearborn J, Concato J, Myers L, Bravata DM. Association Between Statin Utilization and Short- and Long-term Mortality Among Patients With TIA and Ischemic Stroke. [Abstract]. Stroke. 2019 Feb 1; 50(Suppl 1):WP514.
Abstract: Introduction: Current hyperlipidemia guidelines recommend prescribing a moderate/high potency statin after a cerebrovascular event. We sought to compare 30-day and 1-year mortality rates among patients who were discharged on moderate/high potency statin versus those discharged on low dose or no statin. Methods: Administrative data from 10,871 Veterans presenting to one of 134 Veterans Health Administration facilities with a stroke/TIA in fiscal year 2011 were analyzed. Statin medication was assessed two times: at the time of admission and within 7 days of discharge. Each time point was categorized as low, moderate, or high potency, thus creating six mutually categories. Patients were considered at goal if they were prescribed moderate/high-potency statin at baseline and within 7-days of discharge. Deintensification occurred when patients were at goal at baseline but not at the second-time point. We used multivariate logistic regressions to compare the 30-day and 1-year mortality among statin treatment groups, controlling for patients' demographic characteristics and medical comorbidities. Results: Among 9,380 eligible patients (86.3%), 79.5 % (n=7,456) were prescribed statins by the 7-days post-discharge, with a majority (59.2%) of patients receiving moderate/high potency statins. The multivariate regression analysis did not identify a significant difference in 30-day or 1-year post-event mortality among patients receiving moderate/high potency statins at both time points or at the second-time point (purple and orange shading in the table). Statin deintensification or never receiving a statin was associated with 1.26 to 1.93 higher odds of mortality as compared to participants who were on medium or high potency statins. Conclusions: Prescribing moderate/high potency statins soon after a cerebrovascular event is associated with reduced short- and long-term mortality, whereas statin deintensification is associated with worse outcomes. This data supports current secondary stroke prevention guidelines. Providers should be aware that deintensifying statin therapy is associated with worse post-stroke/TIA outcomes