Statin therapy in ischemic stroke patients with atrial fibrillation: Efficacy and safety outcomes
2025; SAGE Publishing; Linguagem: Inglês
10.1177/23969873241307520
ISSN2396-9881
AutoresMichele Marvardi, Maurizio Paciaroni, Valeria Caso, Michele Marvardi, Mario Ferrante, Azmil H. Abdul‐Rahim, MD Georgios Tsivgoulis, David Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Tolga Dittrich, Virginia Cancelloni, Annaelle Zietz, Gian Marco De Marchis, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Peter Vanacker, Susanna M. Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Cecilia Becattini, Rosario Pascarella, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Ilaria Leone De Magistris, Maria Giulia Mosconi, Michela Giustozzi, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Anastasia Adamou, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Sílvia Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, M Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Yuriy Flomin, Michelangelo Mancuso, Roberto D’Agliano, Marco Baldini, Leonardo Ulivi, Nicola Giannini, Κonstantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Panagiotis Halvatsiotis, Efstathia Karagkiozi, George Athanasakis, Konstantinos Makaritsis, Alessia Lanari, Turgut Tatlisumak, Monica Acciarresi, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, Sung‐Il Sohn, Nicola Mumoli, Davide Carrara, Miriam Maccarrone, Franco Galati, Vanessa Gourbali, Giovanni Orlandi, Martina Giuntini, Francesco Corea, Marta Bellesini, Theodoros Karapanayiotides, László Csiba, Lilla Szabó, Davide Imberti, Alessio Pieroni, Kristian Barlinn, Lars-Peder Pallesen, Jessica Barlinn, Б. М. Доронин, Vera Volodina, Giancarlo Agnelli, Dirk Deleu, Bruno Bonetti, Luana Gentile, Giuseppe Reale, Pietro Caliandro, Andrea Morotti, Vieri Vannucchi, Marina Padroni, Federica Letteri, Mauro Magoni, Cindy Tiseo, Alberto Rigatelli, Aurelia Zauli, Francesco Bossi, Maurizio Paciaroni, Valeria Caso,
Tópico(s)Atrial Fibrillation Management and Outcomes
ResumoIntroduction: The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducted a sub-analysis of the RAF and RAF-NOAC studies to evaluate the efficacy and safety of statins in secondary prevention in patients with acute ischemic stroke and AF. Materials and methods: We combined patient data from the RAF and RAF-NOAC studies, prospective observational studies conducted across Stroke Units in Europe, the United States, and Asia from January 2012 to June 2016. We included consecutive patients with AF who suffered an acute ischemic stroke with a follow-up of 90 days. Our outcomes were the combined endpoint, including stroke, transient ischemic attack, systemic embolism, symptomatic intracerebral hemorrhage, and major extracranial bleeding. Furthermore, both ischemic and hemorrhagic outcomes were evaluated separately. Results: A total of 1742 patients were included (46% male), and 898 (52%) received statins after the index event, of whom 436 (48.6%) were already taking statins before the index event, 462 (51.4%) started treatment after. At multivariable analysis, statin use was statistically associated with age (OR 0.92, 95% CI 0.97–0.99, p = 0.001), male sex (OR 1.35, 95% CI 1.07–1.70, p = 0.013), anticoagulation (OR 2.53, 95% CI 1.90–3.36, p < 0.0001), hyperlipidemia (OR 5.52, 95% CI 4.28–7.12, p < 0.0001), paroxysmal AF (OR 1.40, 95% CI 1.12–1.75, p = 0.003), leukoaraiosis (OR 1.39, 95% CI 1.11–1.75, p = 0.004) and heart failure (OR 0.72, 95% CI 0.53–0.98, p = 0.034). Statin use was not associated with the combined outcome event (OR 0.84, 95% CI 0.58–1.23, p = 0.3) and ischemic outcome event (OR 1.17, 95% CI 0.73–1.88, p = 0.5) while was associated with a lower risk of hemorrhagic outcome event (OR 0.51, 95% CI 0.28–0.91, p = 0.02). Discussion: Statins protect cerebral arterial vessels (particularly small vessels) from subacute damage due to hypertension, diabetes, and other harmful agents (such as reactive oxygen species, proinflammatory cytokines, etc.) due to their systemic anti-inflammatory and endothelium-protective effects. Conclusions: Our data show that statins seem to protect against global bleeding events in cardioembolic stroke patients; this may be due to the pleiotropic effect of statins. More data are warranted to confirm these findings.
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