Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use

A population-based study

Samrat Yeramaneni, Dawn O. Kleindorfer, Heidi Sucharew, Kathleen Alwell, Charles J. Moomaw, Matthew L. Flaherty, Daniel Woo, Opeolu Adeoye, Simona Ferioli, Felipe de los Rios La Rosa, Sharyl Martini, Jason Mackey, Pooja Khatri, Brett M. Kissela, Jane C. Khoury

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims: We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods: All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results: Overall, 77% (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72% (n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56% were women, and 21% were black. In adjusted analyses, the HLD/no-statins group showed 35% (adjusted hazard ratio (aHR) = 0.65, 95% CI: 0.46–0.92), 27% (aHR = 0.73, 95% CI: 0.59–0.90), and 17% (aHR = 0.83, 95% CI: 0.70–0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17% significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions: A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.

Original languageEnglish (US)
Pages (from-to)152-160
Number of pages9
JournalInternational Journal of Stroke
Volume12
Issue number2
DOIs
StatePublished - 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hyperlipidemias
Mortality
Population
Stroke
Survival
International Classification of Diseases
Proportional Hazards Models

Keywords

  • Cerebral infarction
  • cholesterol
  • LDL
  • obesity
  • outcomes
  • survival

ASJC Scopus subject areas

  • Neurology

Cite this

Yeramaneni, S., Kleindorfer, D. O., Sucharew, H., Alwell, K., Moomaw, C. J., Flaherty, M. L., ... Khoury, J. C. (2017). Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use: A population-based study. International Journal of Stroke, 12(2), 152-160. https://doi.org/10.1177/1747493016670175

Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use : A population-based study. / Yeramaneni, Samrat; Kleindorfer, Dawn O.; Sucharew, Heidi; Alwell, Kathleen; Moomaw, Charles J.; Flaherty, Matthew L.; Woo, Daniel; Adeoye, Opeolu; Ferioli, Simona; de los Rios La Rosa, Felipe; Martini, Sharyl; Mackey, Jason; Khatri, Pooja; Kissela, Brett M.; Khoury, Jane C.

In: International Journal of Stroke, Vol. 12, No. 2, 2017, p. 152-160.

Research output: Contribution to journalArticle

Yeramaneni, S, Kleindorfer, DO, Sucharew, H, Alwell, K, Moomaw, CJ, Flaherty, ML, Woo, D, Adeoye, O, Ferioli, S, de los Rios La Rosa, F, Martini, S, Mackey, J, Khatri, P, Kissela, BM & Khoury, JC 2017, 'Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use: A population-based study', International Journal of Stroke, vol. 12, no. 2, pp. 152-160. https://doi.org/10.1177/1747493016670175
Yeramaneni, Samrat ; Kleindorfer, Dawn O. ; Sucharew, Heidi ; Alwell, Kathleen ; Moomaw, Charles J. ; Flaherty, Matthew L. ; Woo, Daniel ; Adeoye, Opeolu ; Ferioli, Simona ; de los Rios La Rosa, Felipe ; Martini, Sharyl ; Mackey, Jason ; Khatri, Pooja ; Kissela, Brett M. ; Khoury, Jane C. / Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use : A population-based study. In: International Journal of Stroke. 2017 ; Vol. 12, No. 2. pp. 152-160.
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abstract = "Background: Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims: We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods: All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results: Overall, 77{\%} (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72{\%} (n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56{\%} were women, and 21{\%} were black. In adjusted analyses, the HLD/no-statins group showed 35{\%} (adjusted hazard ratio (aHR) = 0.65, 95{\%} CI: 0.46–0.92), 27{\%} (aHR = 0.73, 95{\%} CI: 0.59–0.90), and 17{\%} (aHR = 0.83, 95{\%} CI: 0.70–0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17{\%} significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions: A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.",
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T2 - A population-based study

AU - Yeramaneni, Samrat

AU - Kleindorfer, Dawn O.

AU - Sucharew, Heidi

AU - Alwell, Kathleen

AU - Moomaw, Charles J.

AU - Flaherty, Matthew L.

AU - Woo, Daniel

AU - Adeoye, Opeolu

AU - Ferioli, Simona

AU - de los Rios La Rosa, Felipe

AU - Martini, Sharyl

AU - Mackey, Jason

AU - Khatri, Pooja

AU - Kissela, Brett M.

AU - Khoury, Jane C.

PY - 2017

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N2 - Background: Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims: We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods: All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results: Overall, 77% (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72% (n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56% were women, and 21% were black. In adjusted analyses, the HLD/no-statins group showed 35% (adjusted hazard ratio (aHR) = 0.65, 95% CI: 0.46–0.92), 27% (aHR = 0.73, 95% CI: 0.59–0.90), and 17% (aHR = 0.83, 95% CI: 0.70–0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17% significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions: A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.

AB - Background: Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims: We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods: All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results: Overall, 77% (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72% (n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56% were women, and 21% were black. In adjusted analyses, the HLD/no-statins group showed 35% (adjusted hazard ratio (aHR) = 0.65, 95% CI: 0.46–0.92), 27% (aHR = 0.73, 95% CI: 0.59–0.90), and 17% (aHR = 0.83, 95% CI: 0.70–0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17% significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions: A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.

KW - Cerebral infarction

KW - cholesterol

KW - LDL

KW - obesity

KW - outcomes

KW - survival

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