SPARCL研究已明確證實他汀類藥物在預防卒中複發和嚴重不良心血管事件(MACE)的有效性，但該研究排除了心源性血栓的首發卒中患者，因此心源性卒中患者是否能從他汀類藥物治療中獲益尚未知，尤其是那些心房顫動(簡稱房顫)患者。為此，台灣學者對他汀類藥物和伴房顫缺血性卒中患者未來血管風險的關係進行了評估，結果表明，應用他汀類藥物與上述患者血管事件(包括卒中)複發風險降低有關。

        研究者們分析了台灣健康保險登記庫中的患者數據，隨訪時間為患者首次發生卒中到因再次發生卒中或心肌梗死的期間，或至撤銷登記以及2011年1月1日之前的最後一次醫療索賠。在隨訪期間，根據是否處方了他汀類藥物將患者分為2組：至少用30天或從未用過他汀類藥物。排除了在終點結束前30天內未應用任何抗栓藥的患者。主要終點為MACE(卒中和心肌梗死複合事件)，主要次要終點為任何卒中的複發。利用Cox模型評估校正多變量的事件危險比(HR)和95%置信區間(CI)。在隨訪期間校正了基線年齡、性別、高血壓、糖尿病、既往卒中和心肌梗死、高脂血症、醫院級別以及抗栓藥的治療。

        結果共入組4455例符合條件的患者，他們的平均年齡為71歲，對其平均隨訪2.8年。與未應用他汀類藥物相比，應用他汀類藥物與MACE(校正HR為0.84，95% CI 0.72~0.99，P=0.04)發生率和卒中複發率(校正HR 0.82，95% CI 0.69~ 0.97，P=0.02)顯著較低有關。他汀還與缺血性卒中風險較低有關，但對顱內出血和心肌梗死的影響為中性。

        該研究於國際卒中大會(ISC2015)壁報上展示，並發表於《卒中》(Stroke)雜誌增刊上。

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        參考文獻：Meng Lee et al. Stroke.2015; 46: TP388 International Stroke Conference Poster Abstracts

• International Stroke Conference Poster Abstracts
Session Title: Preventive Strategies Posters II
Abstract T P388: Statin Use is Linked to Lower Risk of Recurrent Vascular Events among Ischemic Stroke Patients with Atrial Fibrillation
1. Meng Lee1;
2. Yi-Ling Wu1;
3. Jeffrey L Saver2;
4. Jiann-Der Lee1;
5. Hui-Hsuan Wang3;
6. Bruce Ovbiagele4
+Author Affiliations
1. 1Neurology, Chang Gung Univ and Hosp, Puzi, Taiwan
2. 2Neurology, UCLA Stroke Cntr, Los Angeles, CA
3. 3Chang Gung Univ, Taoyuan, Taiwan
4. 4Univ of South Carolina, Charleston, SC

Abstract
Background: The efficacy of statin therapy in the prevention of recurrent stroke and major adverse cardiovascularevents (MACE) was clearly established by the SPARCL trial; but SPARCL excluded patients whose index stroke was due to a presumed cardioembolic mechanism. As such, it remains unclear whether statins are beneficial in cardioembolic stroke patients, particularly those with atrial fibrillation (AF).

Objective: To evaluate the relationship between statin use and future vascular risk reduction among recent ischemic stroke patients with AF
Methods: We analyzed the Taiwan National Health Insurance registry which comprises beneficiaries aged ≥ 18 years. Code ICD-9 was used to identify a primary hospitalization diagnosis of ischemic stroke and AF among subjects encountered between 2003 and 2009. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction; withdrawal from the registry; and last medical claim before 1/1/2011. Patients were divided into 2 groups based on whether statin was prescribed (at least 30 days vs. never used) during the follow-up period. Patients were excluded if they did not take any antithrombotic agent within 30 days before an endpoint. Primary endpoint was MACE (composite of stroke and myocardial infarction) and a key secondary endpoint was any recurrent stroke. Multivariate-adjusted hazard ratio (HR) and 95% CI for the development of events were estimated using Cox models. Model was adjusted for baseline age, gender, hypertension, diabetes, prior stroke, prior myocardial infarction, hyperlipidemia, hospital level, and antithrombotic agent during follow-up.
Results: Among 4455 eligible patients, mean age was 71 years and mean follow-up duration was 2.8 years.Compared to non-statin use, statin use was associated with a significantly lower occurrence of MACE (adjusted HR 0.84, 95% CI 0.72 to 0.99, P=0.04) and recurrent stroke (adjusted HR 0.82, 0.69 to 0.97, P=0.02). Statin use was also linked to lower ischemic stroke risk, but had neutral effects on intracranial hemorrhage and myocardial infarction.
Conclusion: Among patients with an index ischemic stroke and AF, statin use is associated with a lower risk of recurrent vascular events including stroke.