Statins after ischemic stroke of undetermined etiology in young adults

Abstract

To investigate the use of statins and their effect on the risk for subsequent vascular events in young adults with ischemic stroke of undetermined etiology. From our database of 1,008 consecutive patients aged 15-49 with first-ever ischemic stroke between 1994 and 2007 (mean follow-up in survivors 9.0 ± 4.0 years), we selected those with an unknown etiology, comprehensive diagnostic evaluation, and information on statin use during the follow-up. The 3 groups of statin users were never used, continuous use, and discontinuous use. The outcome event was the composite endpoint of stroke, myocardial infarction, other arterial thrombosis, revascularization, or vascular death. Of the 215 patients included (mean age 39.1 ± 8.6 years), 72 (33%) used a statin at some time during follow-up. These patients were likely to be older, have a poorer lipid profile, and have hypertension. Twenty-nine (20%) events occurred among the 143 patients never on a statin, none among the 36 with continuous statin, and 4 (11%) among the 36 with discontinuous statin. In a Cox proportional hazards analysis adjusted for age, sex, dyslipidemia, hypertension, antihypertensive medication, stroke year, and propensity score, patients on a statin at any time during follow-up were less likely to experience outcome events (hazard ratio 0.23, 95% confidence interval 0.08-0.66; p = 0.006). Young patients with a first ischemic stroke of undetermined etiology who used statin poststroke had lower rates of new vascular events in a long-term follow-up.