Statin effects in atrial fibrillation-related stroke: A systematic review and meta-analysis

Abstract

Effects of statins on atrial fibrillation (AF)-related stroke are not well established. We aimed to evaluate whether statin therapy is associated with mortality and recurrent cardiovascular events after AF-related stroke by conducting a systematic review and meta-analysis of recent observational studies. Electronic databases (PubMed, EMBASE, and Cochrane library) were searched to identify literature investigating the effect of pre- and post-stroke statins on clinical outcomes in AF–related stroke patients. The primary outcome was all-cause mortality. Secondary outcomes were recurrent ischemic stroke, recurrent all-type stroke, myocardial infarction, major adverse cardiovascular events (MACE), and poor functional outcome (mRS 4-6) at discharge. We extracted adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) from multivariable analysis of each study to diminish limitations of observational studies. The pooled estimates on each outcome were acquired. A total of 6 studies were divided into post-stroke statin group (n=5) and pre-stroke statin group (n=2). Post-stroke statin therapy was associated with reduced risk of all-cause mortality (HR, 0.64; 95% CI, 0.55–0.74, I2=13%). Regarding to recurrent ischemic stroke, post-stroke statin was not effective to prevent event (HR, 0.99; 95% CI, 0.80-1.21, I2=21%). There were no significant association between post-stroke statin therapy and risk reduction of recurrent stroke, myocardial infarction, or MACE. Pre-stroke statin use was associated with a low risk of poor functional outcome at discharge (HR, 0.76; 95% CI, 0.60-0.96, I2=9%). In these meta-analyses, statin therapy was associated with risk reduction of all-cause mortality and poor functional outcome in patients with AF-related stroke.