A Retrospective Study on Statins and Post-stroke Patients: What About Functional Outcome and Follow-Up in a Stroke Rehabilitation Cohort?

Chiara Mele,Andrea Giordano,Giorgio Maggioni,Caterina Pistarini,Clara Lunardon,Alessandra Mazzone,Francesca Balsamo

doi:10.3389/fneur.2021.744732

Chiara Mele, Andrea Giordano + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2021.744732

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Abstract

Objective: Statins exert pleiotropic effects by influencing several mechanisms, including synaptogenesis, neurogenesis, cerebral flow regulation, and angiogenesis. Results from in vitro and animal models suggest that statins could have beneficial effect on functional recovery and outcome after stroke events. However, results in human studies are still controversial. The aim of our study was to evaluate the role of statin in influencing functional outcome and subsequent clinical follow-up in a large cohort of post-stroke rehabilitation patients.Methods: This retrospective study consecutively enrolled 413 adult patients with stroke event, admitted to the division of Neurorehabilitation of the IRCCS ICS Maugeri, Veruno (Italy), for an individual rehabilitation program between 2015 and 2017. Follow-up lasted 3–5 years after discharge. Demographic data, etiology, classification, and anatomical site of stroke lesion, functional assessment, use and duration of statin therapy, and death during hospitalization were collected at baseline and on discharge. Clinical data on subsequent follow-up were also evaluated, considering these as variables: stroke recurrence, bone fractures, cardiovascular complications, and death.Results: In our cohort, 177 patients (42.9%) were prescribed statin therapy, of whom 50 (28.2%) before the stroke event and 127 (71.8%) at the beginning of the rehabilitation process. The use and type of statin therapy as well as the duration of treatment were not associated with recovery and functional outcome, regardless of confounders including sex, age, etiology, and site of stroke lesion, and initial functional level. For what concern post-discharge clinical follow-up, the use of statin therapy was significantly associated with a lower risk of bone fractures (OR = 0.095, CI 95%: 0.012–0.743, p = 0.01) independently from age, sex, initial and final functional level, and comorbidities.Conclusions: The use of statins does not seem to influence the functional outcome in post-stroke patients. However, they could exert a protective role against bone fractures during post-discharge follow-up, suggesting further evaluation on this topic.

Highlights

Statins, known as HMG-CoA reductase inhibitors, represent a widely used class of cholesterol-lowering medications, able to reduce morbidity and mortality in individuals at high risk of cardiovascular diseases [1]
The results of our study show that the use and type of statin therapy as well as the duration of treatment were not significantly associated with the recovery and functional outcome in terms of Functional Independence Measure (FIM), regardless of confounders including sex, age, etiology, and site of stroke lesion, initial functional level, and comorbidities
With the aim of clarifying this issue, we evaluated the possible role of statins in influencing the functional outcome in terms of FIM in a large cohort of stroke patients with different etiology, by using a multinomial logistic regression analysis in order to eliminate the effect of possible confounders including age, sex, etiology and site of stroke lesion, initial functional level, and comorbidities

Summary

Introduction

Known as HMG-CoA reductase inhibitors, represent a widely used class of cholesterol-lowering medications, able to reduce morbidity and mortality in individuals at high risk of cardiovascular diseases [1]. Several randomized clinical trials demonstrated that statin prevents stroke in patients with cardiovascular risk factors and in survivors of first stroke [2, 3]. Stroke events are often associated with short- and longterm disability including immobilization, gait and balance impairment, cognitive deficits, and increased risk of falling and bone fractures [4, 5]

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