Ip, Bonaventure; Yip, Terry; Hung, Trista; Yam, Tsz-Fai; Yeung, Carly; Ko, Ho; Wong, Grace; Leng, Xinyi; Mok, Vincent; Soo, Yannie; Seiffge, David; Shoamanesh, Ashkan; Leung, Thomas (2024). Lipid control and stroke risk in atrial fibrillation patients treated with direct oral anticoagulants and statins. (In Press). European stroke journal, 23969873241272530, p. 23969873241272530. Sage 10.1177/23969873241272530
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INTRODUCTION
The risk of ischemic stroke and intracerebral hemorrhage (ICH) with intensive lipid control by statins among patients with atrial fibrillation (AF) who require direct oral anticoagulants (DOAC) is unclear. We aimed to determine the risks of ischemic stroke and ICH in AF patients treated with DOAC and statins.
PATIENTS AND METHODS
In a population-based retrospective cohort study, we identified AF patients concurrently on DOAC and statins from 2015 to 2021 in Hong Kong. Primary outcome was ischemic stroke. Secondary outcomes were ICH and death. We correlated study outcomes with low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) as time-varying, continuous variables with restricted cubic spline. In secondary analyses, the risks of study outcomes with statin intensity (low, moderate, high) were determined by multivariable time-dependent marginal structural Cox models.
RESULTS
We identified 32,752 AF patients co-prescribed with DOAC and statins. Lower LDL-C (p < 0.001) and higher HDL-C (p < 0.001) levels were associated with lower risk of ischemic stroke but not significantly associated with ICH. LDL-C of <1.8 mmol/L (70 mg/dL) was not associated with mortality (19.6% vs 18.4%, difference 1.2% [95% CI -0.35 to 2.13]). High-intensity statin was associated with a lower risk of ischemic stroke compared with low-intensity statin (weighted Cox-specific hazard ratio [95% CI]: 0.82 [0.67-0.99], p = 0.040) independent of LDL-C levels. Similar associations were found in 11,444 AF patients with a history of ischemic stroke.
DISCUSSION AND CONCLUSION
Intensive lipid control by high-intensity statins was associated with a lower risk of ischemic stroke in AF patients who required DOACs and did not appear to increase the risk of ICH.
Item Type: |
Journal Article (Original Article) |
---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Seiffge, David Julian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2396-9873 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
20 Aug 2024 08:39 |
Last Modified: |
21 Aug 2024 04:14 |
Publisher DOI: |
10.1177/23969873241272530 |
PubMed ID: |
39158514 |
Uncontrolled Keywords: |
Atrial fibrillation anticoagulants cholesterol intracerebral hemorrhage statins stroke |
BORIS DOI: |
10.48350/199844 |
URI: |
https://boris.unibe.ch/id/eprint/199844 |