Use of lipid-lowering therapy after ischaemic stroke and expected benefit from intensification of treatment.
hyperlipidemias
medication adherence
pharmacology, clinical
stroke
Journal
Open heart
ISSN: 2053-3624
Titre abrégé: Open Heart
Pays: England
ID NLM: 101631219
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
19
01
2022
accepted:
05
04
2022
entrez:
23
4
2022
pubmed:
24
4
2022
medline:
27
4
2022
Statut:
ppublish
Résumé
Elevated low-density lipoprotein cholesterol (LDL-C) increases the risk of recurrent cardiovascular disease (CVD) events. We examined use of lipid-lowering therapy (LLT) following ischaemic stroke, and estimated benefits from guideline-based up-titration of LLT. The Norwegian COgnitive Impairment After STroke (Nor-COAST) study, a multicentre prospective cohort study, collected data on LLT use, dose intensity and LDL-C levels for 462 home-dwelling patients with ischaemic stroke. We used the Secondary Manifestations of Arterial Disease-Reduction of Atherothrombosis for Continued Health (SMART-REACH) model to estimate the expected benefit of up-titrating LLT. At discharge, 92% received LLT (97% statin monotherapy). Patients with prestroke dementia and cardioembolic stroke aetiology were less likely to receive LLT. Older patients (coefficient -3 mg atorvastatin per 10 years, 95% CI -6 to -0.5) and women (coefficient -5.1 mg atorvastatin, 95% CI -9.2 to -0.9) received lower doses, while individuals with higher baseline LDL-C, ischaemic heart disease and large artery stroke aetiology received higher dose intensity. At 3 months, 45% reached LDL-C ≤1.8 mmol/L, and we estimated that 81% could potentially reach the target with statin and ezetimibe, resulting in median 5 (IQR 0-12) months of CVD-free life gain and median 2% 10-year absolute risk reduction (IQR 0-4) with large interindividual variation. Potential for optimisation of conventional LLT use exists in patients with ischaemic stroke. Awareness of groups at risk of undertreatment and objective estimates of the individual patient's benefit of intensification can help personalise treatment decisions and reduce residual cholesterol risk. NCT02650531.
Identifiants
pubmed: 35459718
pii: openhrt-2022-001972
doi: 10.1136/openhrt-2022-001972
pmc: PMC9036470
pii:
doi:
Substances chimiques
Cholesterol, LDL
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Atorvastatin
A0JWA85V8F
Banques de données
ClinicalTrials.gov
['NCT02650531']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
JAMA. 2004 Apr 21;291(15):1864-70
pubmed: 15100205
Eur Heart J. 2021 Sep 7;42(34):3227-3337
pubmed: 34458905
Clin Epidemiol. 2020 Dec 01;12:1327-1336
pubmed: 33293871
Eur J Prev Cardiol. 2021 Sep 20;28(11):1279-1289
pubmed: 33580789
Ir J Med Sci. 2018 Aug;187(3):739-746
pubmed: 29368282
Clin Epidemiol. 2021 Sep 17;13:813-823
pubmed: 34566434
BMC Neurol. 2018 Nov 26;18(1):193
pubmed: 30477436
N Engl J Med. 2020 Jan 2;382(1):9
pubmed: 31738483
BMC Neurol. 2014 Mar 21;14:53
pubmed: 24650199
J Am Heart Assoc. 2018 Aug 21;7(16):e009217
pubmed: 30369323
Stroke. 2013 Sep;44(9):2427-33
pubmed: 23860300
Clin Epidemiol. 2019 Jun 28;11:495-508
pubmed: 31388316
Lancet. 2010 Nov 13;376(9753):1670-81
pubmed: 21067804
Age Ageing. 2013 Jan;42(1):62-9
pubmed: 22910303
Neurology. 2020 May 12;94(19):e1984-e1995
pubmed: 32273430
J Intern Med. 2021 Mar;289(3):355-368
pubmed: 32743852
Eur J Prev Cardiol. 2015 Oct;22(10):1354-62
pubmed: 25139770
N Engl J Med. 2006 Aug 10;355(6):549-59
pubmed: 16899775
BMJ Open. 2018 May 26;8(5):e021309
pubmed: 29804065
Eur J Clin Pharmacol. 2013 May;69(5):1173-80
pubmed: 23187964
JAMA Cardiol. 2017 Sep 1;2(9):959-966
pubmed: 28768335
Atherosclerosis. 2019 Jun;285:135-146
pubmed: 31054483
Atherosclerosis. 2021 May;325:99-109
pubmed: 33892925
J Am Heart Assoc. 2019 Oct;8(19):e013229
pubmed: 31554462
Eur Heart J. 2020 Jan 1;41(1):111-188
pubmed: 31504418
Eur J Prev Cardiol. 2020 May 13;:
pubmed: 33611511
Med Care. 1986 Jan;24(1):67-74
pubmed: 3945130