Abstract：
BACKGROUND: Statins are essential for secondary prevention after ischaemic stroke (IS). However, statin intensity recommendations differ, and there is a concern about intracerebral haemorrhage (ICH). We studied the long-term impacts of initial statin intensity following IS.
METHODS: Consecutive patients using high-intensity, moderate-intensity or low-intensity statin early after IS (n=45 512) were retrospectively studied using national registries in Finland. Differences were adjusted using multivariable regression. The primary outcome was all-cause death within 12-year follow-up (median 5.9 years). Secondary outcomes were recurrent IS, cardiovascular death and ICH studied using competing risk analyses.
RESULTS: High-intensity therapy was initially used by 16.0%, moderate-intensity by 73.8% and low-intensity by 10.2%. Risk of death was lower with high-intensity versus moderate-intensity (adjusted HR (adj.HR) 0.92; 95% CI 0.87 to 0.97; number needed to treat (NNT) 32.0), with moderate-intensity versus low-intensity (adj.HR 0.91; 95% CI 0.87 to 0.95; NNT 27.5) and with high-intensity versus low-intensity (adj.HR 0.83; 95% CI 0.78 to 0.89; NNT 14.6) statin. There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS (p<0.0001) and cardiovascular death (p<0.0001). The occurrence of ICH was not associated with initial statin intensity (p=0.646).
CONCLUSIONS: Following IS, more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH. These findings emphasise the importance of high statin intensity shortly after IS.
METHODS: Consecutive patients using high-intensity, moderate-intensity or low-intensity statin early after IS (n=45 512) were retrospectively studied using national registries in Finland. Differences were adjusted using multivariable regression. The primary outcome was all-cause death within 12-year follow-up (median 5.9 years). Secondary outcomes were recurrent IS, cardiovascular death and ICH studied using competing risk analyses.
RESULTS: High-intensity therapy was initially used by 16.0%, moderate-intensity by 73.8% and low-intensity by 10.2%. Risk of death was lower with high-intensity versus moderate-intensity (adjusted HR (adj.HR) 0.92; 95% CI 0.87 to 0.97; number needed to treat (NNT) 32.0), with moderate-intensity versus low-intensity (adj.HR 0.91; 95% CI 0.87 to 0.95; NNT 27.5) and with high-intensity versus low-intensity (adj.HR 0.83; 95% CI 0.78 to 0.89; NNT 14.6) statin. There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS (p<0.0001) and cardiovascular death (p<0.0001). The occurrence of ICH was not associated with initial statin intensity (p=0.646).
CONCLUSIONS: Following IS, more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH. These findings emphasise the importance of high statin intensity shortly after IS.
摘要：
背景：他汀类药物对于缺血性卒中（IS）后的二级预防至关重要。然而,他汀类药物强度建议不同，并且人们担心脑出血（ICH）。我们研究了IS后初始他汀类药物强度的长期影响。
方法：连续患者使用高强度，采用芬兰国家注册中心对IS后早期的中强度或低强度他汀类药物(n=45512)进行了回顾性研究.使用多变量回归校正差异。主要结果是12年随访期间的全因死亡（中位数为5.9年）。次要结果是复发性IS，使用竞争风险分析研究心血管死亡和ICH.
结果：最初使用高强度治疗的比例为16.0％，中等强度为73.8%，低强度为10.2%。高强度与中等强度的死亡风险较低（调整后的HR（调整。HR）0.92；95%CI0.87至0.97；治疗所需数量（NNT）32.0），中等强度与低强度(调整。HR0.91；95%CI0.87至0.95；NNT27.5），高强度与低强度（调整。HR0.83；95%CI0.78至0.89；NNT14.6)他汀类药物。初始他汀类药物强度与复发性IS（p<0.0001）和心血管死亡（p<0.0001）的较低概率存在剂量依赖性关联。ICH的发生与初始他汀类药物强度无关（p=0.646）。
结论：遵循IS，更强烈的初始他汀类药物治疗与改善长期结局相关,但与ICH风险无关.这些发现强调了IS后不久高他汀类药物强度的重要性。
方法：连续患者使用高强度，采用芬兰国家注册中心对IS后早期的中强度或低强度他汀类药物(n=45512)进行了回顾性研究.使用多变量回归校正差异。主要结果是12年随访期间的全因死亡（中位数为5.9年）。次要结果是复发性IS，使用竞争风险分析研究心血管死亡和ICH.
结果：最初使用高强度治疗的比例为16.0％，中等强度为73.8%，低强度为10.2%。高强度与中等强度的死亡风险较低（调整后的HR（调整。HR）0.92；95%CI0.87至0.97；治疗所需数量（NNT）32.0），中等强度与低强度(调整。HR0.91；95%CI0.87至0.95；NNT27.5），高强度与低强度（调整。HR0.83；95%CI0.78至0.89；NNT14.6)他汀类药物。初始他汀类药物强度与复发性IS（p<0.0001）和心血管死亡（p<0.0001）的较低概率存在剂量依赖性关联。ICH的发生与初始他汀类药物强度无关（p=0.646）。
结论：遵循IS，更强烈的初始他汀类药物治疗与改善长期结局相关,但与ICH风险无关.这些发现强调了IS后不久高他汀类药物强度的重要性。
