Effect of Statin Intensity on the Risk of Epilepsy After Ischaemic Stroke: Real-World Evidence from Population-Based Health Claims
Journal
CNS Drugs
Journal Volume
32
Journal Issue
4
Pages
367
Date Issued
2018
Author(s)
Abstract
© 2018, Springer International Publishing AG, part of Springer Nature. Background: Statins possess neuroprotective effects. However, real-world evidence supporting their utility in post-stroke epilepsy (PSE) prevention is limited. Objective: The association between statin use, including timing of prescribing (pre-stroke vs post-stroke), type (lipophilicity, intensity of therapy) and dose intensity, and risk of developing PSE were investigated by studying Taiwanese health claims (2003–2013). Methods: Patients with new-onset ischaemic stroke were identified. The main outcome was a diagnosis of epilepsy after ischaemic stroke. According to pre-stroke statin use, groups of current users, former users, and non-users were compared using ANOVA. An extended Cox regression model was utilized to estimate the hazard ratio (HR) of PSE, with post-stroke statin use and certain comedications as time-dependent variables. Serial sensitivity analyses were performed to ensure study robustness. Results: Of the 20,858 ischaemic stroke patients, 954 (4.6%) developed PSE. Post-stroke statin use (adjusted HR (aHR) 0.55; 95% confidence interval 0.46–0.67, p < 0.001), but not pre-stroke statin use was associated with a significantly reduced risk of developing PSE. A dose-response correlation was also observed between PSE risk reduction and quartiles of the statin cumulative defined daily dose (cDDD) (aHR 0.84, 0.67, 0.53, and 0.50 for the lowest, second, third, and highest quartiles of cDDD, respectively). Risk predictors and protectors against PSE were also characterized. Conclusion: The post-stroke use of statins after ischaemic stroke was associated with PSE risk reduction in a cDDD-dependent manner. Further clinical studies on the potential applications of statins for PSE prophylaxis, particularly among at-risk patients, are warranted.
SDGs
Other Subjects
atorvastatin; carbapenem; ezetimibe; fibric acid derivative; fluindostatin; hydroxymethylglutaryl coenzyme A reductase inhibitor; low density lipoprotein cholesterol; metformin; mevinolin; neuroleptic agent; pitavastatin; pravastatin; rosuvastatin; serotonin noradrenalin reuptake inhibitor; serotonin uptake inhibitor; simvastatin; hydroxymethylglutaryl coenzyme A reductase inhibitor; adult; Article; brain ischemia; clinical assessment; comorbidity; disease association; dose response; drug effect; epilepsy; evidence based practice; female; human; lipophilicity; major clinical study; male; neuroprotection; outcome assessment; population health; post stroke epilepsy; post stroke epilepsy; prescription; priority journal; risk assessment; risk factor; risk reduction; sensitivity analysis; aged; brain ischemia; cerebrovascular accident; complication; epilepsy; factual database; health insurance; longitudinal study; risk; Taiwan; Aged; Brain Ischemia; Databases, Factual; Dose-Response Relationship, Drug; Epilepsy; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Insurance, Health; Longitudinal Studies; Male; Risk; Stroke; Taiwan
Publisher
ADIS INT LTD
Type
journal article