他汀类药物应用的证据主要来自于选择性临床试验人群，这些人群常常是无并存疾病的和较年轻的受试者。近期，美国和加拿大学者们在老年人群中对他汀类药物治疗的临床有效性进行了评估，结果表明，在真实世界人群中，老年未应用过他汀的缺血性卒中患者出院后他汀类药物治疗与出院后2年期间住院减少和严重不良心血管事件(MACE)以及全因死亡风险较低有关。

        该项名为“PROSPER”的研究纳入了在2007年至2011年入院未应用他汀且年龄在65岁以上的缺血性卒中患者77468例。主要转归为出院后生存时间(Home time，生存天数和急性期或急性期护理后的天数)和MACE;次要转归包括全因死亡、全因再入院、心血管再入院和出血性卒中的发生。校正治疗组间基线差异后，利用负二项和Cox模型评估出院后他汀类药物的应用与转归的关系。

        结果显示，有54991例 (71%)患者出院后用他汀类药物治疗。与那些未接受他汀类药物治疗的患者相比，接受他汀治疗的患者更年轻，且更可能为吸烟者;接受他汀类药物治疗患者的2年内未校正MACE发生率、死亡率和心血管再入院率均较低。

        校正反概率加权后，他汀类药物治疗不仅与出院后2年期间住院天数减少28天有关(P <0.001)，还与MACE、死亡和再入院风险分别降低9%、16%和7%有关(P 值均<0.001)。同时，他汀类药物的应用与出血性卒中风险增加无关(P=0.56)。

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

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        参考文献：Emily C O'Brien et al. Stroke.2015; 46: A9 International Stroke Conference Oral Abstracts

• International Stroke Conference Oral Abstracts
Session Title: Health Services, Quality Improvement, and Patient-Centered Outcomes Oral Abstracts I
Abstract 9: Clinical Effectiveness of Statin Therapy after Ischemic Stroke: Primary Results from the PROSPER Study
1. Emily C O'Brien1;
2. Melissa A Greiner2;
3. Ying Xian1;
4. Gregg C Fonarow3;
5. DaiWai M Olson4;
6. Lee H Schwamm5;
7. Deepak L Bhatt5;
8. Eric E Smith6;
9. Lesley Maisch7;
10. Deidre Hannah8;
11. Brianna Lindholm9;
12. Eric D Peterson10;
13. Michael J Pencina11;
14. Adrian F Hernandez1
+Author Affiliations
1. 1Outcomes Rsch and Assessment, Duke Clinical Rsch Institute, Durham, NC
2. 2Duke Clinical Rsch Institute, Durham, NC
3. 3Cardiology, Univ of California, Los Angeles, Los Angeles, CA
4. 4Univ of Texas - Southwestern, Dallas, TX
5. 5Harvard Med Sch, Boston, MA
6. 6Neurology, Univ of Calgary, Calgary, Canada
7. 7Patient Co-Investigator, Amherst, NY
8. 8Patient Co-Investigator, North Richland Hills, TX
9. 9Patient Co-Investigator, Frisco, TX
10. 10Cardiology, Duke Clinical Rsch Institute, Durham, NC
11. 11Biostatistics, Duke Clinical Rsch Institute, Durham, NC

Abstract
Background: Evidence for statin use comes primarily from select clinical trial populations that are often younger without comorbidities. Stroke patients and their caregivers are in need of real-world effectiveness data to better inform decision-making on statin use after stroke.
Methods: PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate the effectiveness of therapies post-stroke. We linked data from Get With The Guidelines-Stroke patients >65 years of age to Medicare claims to capture post-discharge outcomes. Primary outcomes prioritized by patients were: 1) Home time (days alive and out of acute or post-acute care) and 2) Major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, all-cause readmission, CV readmission, and hemorrhagic stroke. We used negative binomial and Cox models to evaluate discharge statins and outcomes with inverse probability weighting (IPW) to adjust for baseline differences by treatment group.
Results: Of 77,468 statin-naïve ischemic stroke patients hospitalized from 2007-2011, n=54,991 (71%) were discharged on statin therapy. Compared with those not receiving a statin, patients receiving a statin were younger and more likely to be smokers. Unadjusted rates of MACE, mortality and CV readmission within 2 years were lower for statin patients compared with those not receiving a statin. After IPW adjustment, statin therapy was associated with 28 more days of home time in the 2-year post-discharge period (P <.001), 9% lower hazard of MACE (P <.001), 16% lower hazard of mortality (P <.001), and 7% lower hazard of readmission (P <.001). Statin use was not associated with increased risk of hemorrhagic stroke (P=0.56).
Conclusions: In a real-world population of older statin-naïve ischemic stroke patients, discharge statin therapy was associated with more days spent at home during the 2-year period after hospitalization and lower risk of both MACE and all-cause mortality.