他汀類藥物應用的證據主要來自於選擇性臨床試驗人群，這些人群常常是無並存疾病的和較年輕的受試者。近期，美國和加拿大學者們在老年人群中對他汀類藥物治療的臨床有效性進行了評估，結果表明，在真實世界人群中，老年未應用過他汀的缺血性卒中患者出院後他汀類藥物治療與出院後2年期間住院減少和嚴重不良心血管事件(MACE)以及全因死亡風險較低有關。

該項名為“PROSPER”的研究納入了在2007年至2011年入院未應用他汀且年齡在65歲以上的缺血性卒中患者77468例。主要轉歸為出院後生存時間(Home time，生存天數和急性期或急性期護理後的天數)和MACE;次要轉歸包括全因死亡、全因再入院、心血管再入院和出血性卒中的發生。校正治療組間基線差異後，利用負二項和Cox模型評估出院後他汀類藥物的應用與轉歸的關係。

結果顯示，有54991例 (71%)患者出院後用他汀類藥物治療。與那些未接受他汀類藥物治療的患者相比，接受他汀治療的患者更年輕，且更可能為吸煙者;接受他汀類藥物治療患者的2年內未校正MACE發生率、死亡率和心血管再入院率均較低。

校正反概率加權後，他汀類藥物治療不僅與出院後2年期間住院天數減少28天有關(P <0.001)，還與MACE、死亡和再入院風險分別降低9%、16%和7%有關(P 值均<0.001)。同時，他汀類藥物的應用與出血性卒中風險增加無關(P=0.56)。

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

點擊進入>>>2015國際卒中大會(ISC)專題報道

參考文獻：Emily C O'Brien et al. Stroke.2015; 46: A9 International Stroke Conference Oral Abstracts

• International Stroke Conference Oral Abstracts
Session Title: Health Services, Quality Improvement, and Patient-Centered Outcomes Oral Abstracts I
Abstract 9: Clinical Effectiveness of Statin Therapy after Ischemic Stroke: Primary Results from the PROSPER Study
1. Emily C O'Brien1;
2. Melissa A Greiner2;
3. Ying Xian1;
4. Gregg C Fonarow3;
5. DaiWai M Olson4;
6. Lee H Schwamm5;
7. Deepak L Bhatt5;
8. Eric E Smith6;
9. Lesley Maisch7;
10. Deidre Hannah8;
11. Brianna Lindholm9;
12. Eric D Peterson10;
13. Michael J Pencina11;
14. Adrian F Hernandez1
+Author Affiliations
1. 1Outcomes Rsch and Assessment, Duke Clinical Rsch Institute, Durham, NC
2. 2Duke Clinical Rsch Institute, Durham, NC
3. 3Cardiology, Univ of California, Los Angeles, Los Angeles, CA
4. 4Univ of Texas - Southwestern, Dallas, TX
5. 5Harvard Med Sch, Boston, MA
6. 6Neurology, Univ of Calgary, Calgary, Canada
7. 7Patient Co-Investigator, Amherst, NY
8. 8Patient Co-Investigator, North Richland Hills, TX
9. 9Patient Co-Investigator, Frisco, TX
10. 10Cardiology, Duke Clinical Rsch Institute, Durham, NC
11. 11Biostatistics, Duke Clinical Rsch Institute, Durham, NC

Abstract
Background: Evidence for statin use comes primarily from select clinical trial populations that are often younger without comorbidities. Stroke patients and their caregivers are in need of real-world effectiveness data to better inform decision-making on statin use after stroke.
Methods: PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate the effectiveness of therapies post-stroke. We linked data from Get With The Guidelines-Stroke patients >65 years of age to Medicare claims to capture post-discharge outcomes. Primary outcomes prioritized by patients were: 1) Home time (days alive and out of acute or post-acute care) and 2) Major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, all-cause readmission, CV readmission, and hemorrhagic stroke. We used negative binomial and Cox models to evaluate discharge statins and outcomes with inverse probability weighting (IPW) to adjust for baseline differences by treatment group.
Results: Of 77,468 statin-naïve ischemic stroke patients hospitalized from 2007-2011, n=54,991 (71%) were discharged on statin therapy. Compared with those not receiving a statin, patients receiving a statin were younger and more likely to be smokers. Unadjusted rates of MACE, mortality and CV readmission within 2 years were lower for statin patients compared with those not receiving a statin. After IPW adjustment, statin therapy was associated with 28 more days of home time in the 2-year post-discharge period (P <.001), 9% lower hazard of MACE (P <.001), 16% lower hazard of mortality (P <.001), and 7% lower hazard of readmission (P <.001). Statin use was not associated with increased risk of hemorrhagic stroke (P=0.56).
Conclusions: In a real-world population of older statin-naïve ischemic stroke patients, discharge statin therapy was associated with more days spent at home during the 2-year period after hospitalization and lower risk of both MACE and all-cause mortality.