SPARCL研究已明确证实他汀类药物在预防卒中复发和严重不良心血管事件(MACE)的有效性，但该研究排除了心源性血栓的首发卒中患者，因此心源性卒中患者是否能从他汀类药物治疗中获益尚未知，尤其是那些心房颤动(简称房颤)患者。为此，台湾学者对他汀类药物和伴房颤缺血性卒中患者未来血管风险的关系进行了评估，结果表明，应用他汀类药物与上述患者血管事件(包括卒中)复发风险降低有关。

        研究者们分析了台湾健康保险登记库中的患者数据，随访时间为患者首次发生卒中到因再次发生卒中或心肌梗死的期间，或至撤销登记以及2011年1月1日之前的最后一次医疗索赔。在随访期间，根据是否处方了他汀类药物将患者分为2组：至少用30天或从未用过他汀类药物。排除了在终点结束前30天内未应用任何抗栓药的患者。主要终点为MACE(卒中和心肌梗死复合事件)，主要次要终点为任何卒中的复发。利用Cox模型评估校正多变量的事件危险比(HR)和95%置信区间(CI)。在随访期间校正了基线年龄、性别、高血压、188bet在线平台网址 、既往卒中和心肌梗死、高脂血症、医院级别以及抗栓药的治疗。

        结果共入组4455例符合条件的患者，他们的平均年龄为71岁，对其平均随访2.8年。与未应用他汀类药物相比，应用他汀类药物与MACE(校正HR为0.84，95% CI 0.72~0.99，P=0.04)发生率和卒中复发率(校正HR 0.82，95% CI 0.69~ 0.97，P=0.02)显著较低有关。他汀还与缺血性卒中风险较低有关，但对颅内出血和心肌梗死的影响为中性。

        该研究于国际卒中大会(ISC2015)壁报上展示，并发表于《卒中》(Stroke)杂志增刊上。

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        参考文献：Meng Lee et al. Stroke.2015; 46: TP388 International Stroke Conference Poster Abstracts

• International Stroke Conference Poster Abstracts
Session Title: Preventive Strategies Posters II
Abstract T P388: Statin Use is Linked to Lower Risk of Recurrent Vascular Events among Ischemic Stroke Patients with Atrial Fibrillation
1. Meng Lee1;
2. Yi-Ling Wu1;
3. Jeffrey L Saver2;
4. Jiann-Der Lee1;
5. Hui-Hsuan Wang3;
6. Bruce Ovbiagele4
+Author Affiliations
1. 1Neurology, Chang Gung Univ and Hosp, Puzi, Taiwan
2. 2Neurology, UCLA Stroke Cntr, Los Angeles, CA
3. 3Chang Gung Univ, Taoyuan, Taiwan
4. 4Univ of South Carolina, Charleston, SC

Abstract
Background: The efficacy of statin therapy in the prevention of recurrent stroke and major adverse cardiovascularevents (MACE) was clearly established by the SPARCL trial; but SPARCL excluded patients whose index stroke was due to a presumed cardioembolic mechanism. As such, it remains unclear whether statins are beneficial in cardioembolic stroke patients, particularly those with atrial fibrillation (AF).

Objective: To evaluate the relationship between statin use and future vascular risk reduction among recent ischemic stroke patients with AF
Methods: We analyzed the Taiwan National Health Insurance registry which comprises beneficiaries aged ≥ 18 years. Code ICD-9 was used to identify a primary hospitalization diagnosis of ischemic stroke and AF among subjects encountered between 2003 and 2009. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction; withdrawal from the registry; and last medical claim before 1/1/2011. Patients were divided into 2 groups based on whether statin was prescribed (at least 30 days vs. never used) during the follow-up period. Patients were excluded if they did not take any antithrombotic agent within 30 days before an endpoint. Primary endpoint was MACE (composite of stroke and myocardial infarction) and a key secondary endpoint was any recurrent stroke. Multivariate-adjusted hazard ratio (HR) and 95% CI for the development of events were estimated using Cox models. Model was adjusted for baseline age, gender, hypertension, diabetes, prior stroke, prior myocardial infarction, hyperlipidemia, hospital level, and antithrombotic agent during follow-up.
Results: Among 4455 eligible patients, mean age was 71 years and mean follow-up duration was 2.8 years.Compared to non-statin use, statin use was associated with a significantly lower occurrence of MACE (adjusted HR 0.84, 95% CI 0.72 to 0.99, P=0.04) and recurrent stroke (adjusted HR 0.82, 0.69 to 0.97, P=0.02). Statin use was also linked to lower ischemic stroke risk, but had neutral effects on intracranial hemorrhage and myocardial infarction.
Conclusion: Among patients with an index ischemic stroke and AF, statin use is associated with a lower risk of recurrent vascular events including stroke.