Association Between Use of Statins and Survival After Stroke: Real-World Data from The Australian Stroke Clinical Registry

Main Article Content

Lachlan L Dalli
Joosup Kim
Dominique A Cadilhac
Nadine E Andrew
Frank M Sanfilippo
Amanda G Thrift
Vijaya Sundararajan
Monique F Kilkenny


Despite being recommended in clinical guidelines for secondary prevention of stroke, there are limited real-world data on outcomes associated with use of statins post-stroke.

Objectives and Approach
We aimed to investigate the association between statin use and cardiovascular mortality post-stroke. We conducted a retrospective cohort study using prospectively collected data from the Australian Stroke Clinical Registry (2010-2014), linked with national medication dispensing and mortality data. We observed adult patients with first-ever ischaemic stroke or transient ischaemic attack (TIA) for 1-year following hospital discharge, or until their date of death, whichever occurred first. Statin use, defined as having an available statin dispensing, was assessed daily and treated as a time-varying exposure to account for patients who discontinued or reinitiated statins during follow-up. Multivariable, competing-risks regression, with non-cardiovascular death as the competing risk, was used to investigate the association between statin use and 1-year cardiovascular mortality.

Among 8363 patients discharged following first-ever ischaemic stroke or TIA (48% aged ≥75 years, 45% female, 20% TIA, median length-of-stay 5 days), 945 died within 1 year, with 763 deaths being cardiovascular-related. The proportion of statin users was 65% at 90 days, 64% at 180 days, and 62% at 1 year. Groups least likely to be statin users at 1-year were women (odds ratio [OR]: 0.75; 95% CI: 0.67-0.85), patients aged <65 years (OR: 0.80; 95% CI: 0.69-0.92), and those discharged directly home (OR: 0.77; 95% CI: 0.67-0.88). Compared to non-use, use of statins was associated with a reduced risk of cardiovascular mortality within 1 year overall (sub-distribution hazard ratio [SHR]: 0.40; 95% CI: 0.34-0.46), and in sub-groups of patients with TIA, severe stroke, and advanced age.

Conclusion / Implications:
Our preliminary data provide evidence of survival benefits associated with post-stroke statin use. Interventions to improve medication adherence may assist in reducing post-stroke mortality.

Article Details

How to Cite
Dalli, L. L., Kim, J., Cadilhac, D. A., Andrew, N. E., Sanfilippo, F. M., Thrift, A. G., Sundararajan, V. and Kilkenny, M. F. (2020) “Association Between Use of Statins and Survival After Stroke: Real-World Data from The Australian Stroke Clinical Registry”, International Journal of Population Data Science, 5(5). doi: 10.23889/ijpds.v5i5.1505.

Most read articles by the same author(s)

1 2 > >>