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May 15, 2019

ESOC-2019

THERAPEUTIC GAP IN LIPID-LOWERING THERAPY AND OUTCOMES AFTER STROKE: A STUDY OF 10,231 CHINESE STROKE PATIENTS

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ischemic stroke

transient ischemic attack

lipid-lowering treatment

12-month outcomes

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Keywords

ischemic stroke

transient ischemic attack

lipid-lowering treatment

12-month outcomes

Abstract

Background: Guidelines recommend intensive low-density-lipoprotein cholesterol (LDL-C) lowering after ischemic stroke (IS). We evaluated “real-world” temporal trend in lipid-lowering treatment (LLT) and outcomes after IS in a Chinese population. Methods: We retrospectively evaluated consecutive patients admitted with IS or transient ischemic attack (TIA) between January 2005 and September 2017 to an academic institution. Temporal trends in lipid profile, LLT and 12-month major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, myocardial infarction and stroke) were compared between 2005-2008, 2009-2012 and 2013-2017. Multivariate analysis was performed to identify independent outcome predictors. Results: Of 10,231 patients, 95% (n=9,719; mean age 72.1±12.8 years; 52.3% male) survived to hospital discharge (n=3,172 [2005-2008]; n=3,135 [2009-2012]; n=3,412 [2013-2017]). From baseline to month 12, mean LDL-C reduced from 3.0±1.0 to 2.2± 0.8 (2005-2008 and 2009-2012) and 2.7±1 to 2.0±0.7 (2013-2107) (p<0.01). Statin therapy on discharge increased over time from 52.1% to 70.7% and 78.3% (p<0.01). Use of high-intensity statin therapy (1.5%) and proportion of patients who achieved target LDL-C <1.8mmol/L (12.7%) was low. Rates of 12-month IS/TIA decreased over time from 7.7% to 7.1% and 6.2% (p=0.05) and MACCE from 12.5% to 10.9% and 9.3% (p<0.01). Initiation of statin in patients with baseline LDL-C >2.6mmol/L was an independent predictor of lower 12-month MACCE (OR 0.71, 95%CI 0.59-0.85, p<0.01). Conclusions: LLT use after stroke improved over time but remained sub-optimal with significant number of patients not prescribed statins. Use of high-intensity statin and proportion of patients who reached LDL-C goal was very low.

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© Copyright 2019 Morressier GmbH.
All rights reserved.