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Background <p>Patients with ischemic stroke (IS) or TIA face an elevated cardiovascular risk, warranting intensive lipid-lowering therapy. Despite recommendations, adherence to guidelines is suboptimal, leading to frequent undertreatment. This study aims to evaluate the statin use after IS and TIA.</p> Methods <p>LIPYDS is a multicenter, observational, retrospective study including ≥ 18-year-old patients discharged after IS/TIA from 19 Italian centers in 2021. Multivariable logistic regression analysis was used to determine (1) the association between statin prescription (Any-statin <i>versus</i> No-statin), type (High-Intensity-statin <i>versus</i> Other-statin [Moderate/Low-Intensity]) with stroke etiology (TOAST), (2) clinical variables independently associated with statin prescription in the entire cohort and within TOAST categories.</p> Results <p>We included 3,740 patients (median age 75 [IQR 64–82]; median LDL-C 104 [IQR 79–131]). At discharge, 1,971 (52.7%) received a High-intensity-statin, 800 (21.4%) Other-statin, 969 (25.9%) No-statin therapy. Among patients not on statin therapy before the event (<i>N</i> = 2686 [71.8%]), 50.1% initiated High-intensity-statin (78.2% of those with Large-Artery-Atherosclerosis, 60.8% Small-Vessel-Disease, 34.7% Cardioembolic, 47.4% Undetermined etiology); in 33% the decision to abstain from initiating statin therapy persisted. Large-Artery-Atherosclerosis showed the strongest association with Any-statin (aOR 3.07 [95%CI 2.39−3.95], <i>p</i> &lt; 0.001) and High-intensity-statin (aOR 4.51 [95%CI 3.39−6.00], <i>p</i> &lt; 0.001), while Cardioembolic stroke showed an inverse association (respectively, aOR 0.36 [95%CI 0.31−0.43], <i>p</i> &lt; 0.001 and aOR 0.52 [95%CI 0.44−0.62], <i>p</i> &lt; 0.001). Stepwise regression highlighted LDL-C and previous statin therapy as consistent predictors of statin at discharge. Older patients and women were less likely to be on a high-intensity formulation.</p> Conclusion <p>Statins, especially at high-intensity, are under-prescribed after IS and TIA, with older patients, women and those with non-atherosclerotic strokes being the most affected.</p>

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Patterns and predictors of statin therapy after ischemic stroke and TIA: insights from the LIPYDS multicenter study

  • 期刊论文

  • 发表日期：

    2025年1月13日

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  • Angelo Cascio Rizzo,
  • Ghil Schwarz,
  • Matteo Paolucci,
  • Anna Cavallini,
  • Federico Mazzacane,
  • Paolo Candelaresi,
  • Antonio De Mase,
  • Simona Marcheselli,
  • Laura Straffi,
  • Valentina Poretto,
  • Bruno Giometto,
  • Marina Diomedi,
  • Maria Rosaria Bagnato,
  • Marialuisa Zedde,
  • Ilaria Grisendi,
  • Marco Petruzzellis,
  • Debora Galotto,
  • Andrea Morotti,
  • Alessandro Padovani,
  • Novella Bonaffini,
  • Letizia Maria Cupini,
  • Valeria Caso,
  • Francesco Bossi,
  • Cristiano Fanciulli,
  • Maria Maddalena Viola,
  • Alessandra Persico,
  • Emanuele Spina,
  • Anne Falcou,
  • Leonardo Pantoni,
  • Francesco Mele,
  • Mauro Silvestrini,
  • Giovanna Viticchi,
  • Fabio Pilato,
  • Manuel Cappellari,
  • Sabrina Anticoli,
  • Paolo La Spina,
  • Maria Sessa,
  • Danilo Toni,
  • Andrea Zini,
  • Elio Clemente Agostoni

摘要

Background

Patients with ischemic stroke (IS) or TIA face an elevated cardiovascular risk, warranting intensive lipid-lowering therapy. Despite recommendations, adherence to guidelines is suboptimal, leading to frequent undertreatment. This study aims to evaluate the statin use after IS and TIA.

Methods

LIPYDS is a multicenter, observational, retrospective study including ≥ 18-year-old patients discharged after IS/TIA from 19 Italian centers in 2021. Multivariable logistic regression analysis was used to determine (1) the association between statin prescription (Any-statin versus No-statin), type (High-Intensity-statin versus Other-statin [Moderate/Low-Intensity]) with stroke etiology (TOAST), (2) clinical variables independently associated with statin prescription in the entire cohort and within TOAST categories.

Results

We included 3,740 patients (median age 75 [IQR 64–82]; median LDL-C 104 [IQR 79–131]). At discharge, 1,971 (52.7%) received a High-intensity-statin, 800 (21.4%) Other-statin, 969 (25.9%) No-statin therapy. Among patients not on statin therapy before the event (N = 2686 [71.8%]), 50.1% initiated High-intensity-statin (78.2% of those with Large-Artery-Atherosclerosis, 60.8% Small-Vessel-Disease, 34.7% Cardioembolic, 47.4% Undetermined etiology); in 33% the decision to abstain from initiating statin therapy persisted. Large-Artery-Atherosclerosis showed the strongest association with Any-statin (aOR 3.07 [95%CI 2.39−3.95], p < 0.001) and High-intensity-statin (aOR 4.51 [95%CI 3.39−6.00], p < 0.001), while Cardioembolic stroke showed an inverse association (respectively, aOR 0.36 [95%CI 0.31−0.43], p < 0.001 and aOR 0.52 [95%CI 0.44−0.62], p < 0.001). Stepwise regression highlighted LDL-C and previous statin therapy as consistent predictors of statin at discharge. Older patients and women were less likely to be on a high-intensity formulation.

Conclusion

Statins, especially at high-intensity, are under-prescribed after IS and TIA, with older patients, women and those with non-atherosclerotic strokes being the most affected.