Previous studies have suggested that prior treatment with statins is associated with improved outcome of acute ischemic stroke (IS) [1, 2]. However, there are no studies comparing the effects of different statins on IS outcome. We evaluated the effects of prior treatment with statins in 378 consecutive patients (age 78·8 ± 6·5 years) admitted for IS. Overall, 110 patients (29·1%) were taking a statin before admission. At admission, the National Institutes of Health Stroke Scale (NIHSS) score did not differ between patients who were on a statin and those who were not (8·5 ± 9·5 and 9·1 ± 9·7, respectively; P = NS). The modified Rankin scale (mRS) score at discharge was lower in patients who were on a statin than in those who were not (2·2 ± 2·2 and 2·8 ± 2·2, respectively; P = 0·020). Adverse outcome (mRS at discharge ≥2) was less frequent in patients who were on a statin (46·5 vs. 64·5% in those who were not; P = 0·003). In binary logistic regression analysis, predictors of adverse outcome were older age, current smoking, history of stroke, and higher NIHSS score at admission, whereas prior treatment with statins was associated with favorable outcome (Table 1). When the type of statin was entered in the multivariate model, prior treatment with simvastatin (n = 46, median dose 20 mg/day) was associated with a favorable outcome [odds ratio (OR) 0·21, 95% confidence interval (CI) 0·06–0·69, P = 0·011], whereas prior treatment with atorvastatin (n = 45, median dose 20 mg/day) (OR 0·94, 95% CI 0·29–3·01, P = NS) or with all other statins combined (rosuvastatin, pravastatin, or fluvastatin, n = 11, 7, and 1, respectively) (OR 0·19, 95% CI 0·03–1·36, P = NS) was not. In conclusion, treatment with simvastatin prior to stroke appears to be more beneficial than prior treatment with atorvastatin. Given the smaller lipid-lowering potency of simvastatin compared with the same dose of atorvastatin [3], lipid-lowering-independent neuroprotective effects might explain the better outcome observed in simvastatin-treated patients [4, 5].

Table 1. Independent predictors of adverse outcome
ParameterOdds ratio95% Confidence intervalP
  1. NS, not significant.

Nonsmoker (reference)   
Current smoker5·061·27–20·110·021
Past smoker0·580·23–1·50NS
History of stroke2·591·17–5·780·019
National Institutes of Health Stroke Scale score at admission1·641·41–1·90<0·001
Prior treatment with a statin0·360·15–0·860·021


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