Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Cohort
2.3. Study Outcomes
2.4. Study Variables
2.5. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Statin Use and Subsequent ICH
3.3. Statin Use and All-Cause Mortality
3.4. Statin Dosage and Outcomes
4. Discussion
4.1. Statin Use and Subsequent ICH
4.2. Statin Use and All-Cause Mortality
4.3. Other Medications and Comorbidities versus Outcomes
4.4. Statin Dosage and Risks
4.5. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Non-Statin Cohort N = 39,366 | Statin Cohort N = 39,366 | p-Value | |
---|---|---|---|
Age | 67.67 ± 9.09 | 68.16 ± 9.24 | <0.0001 |
Gender | >0.9999 | ||
Female | 17,898 (45.47) | 17,898 (45.47) | |
Male | 21,468 (54.53) | 21,468 (54.53) | |
Statin dose | |||
Low | 12,318 (31.29) | ||
Middle | 21,729 (55.20) | ||
High | 5319 (13.51) | ||
Statin (average days) | |||
Low | 294.84 ± 77.72 | ||
Middle | 242.70 ± 112.38 | ||
High | 209.32 ± 129.71 | ||
Medication | |||
Thrombolytic agents | <3 (<1) a | <3 (<1) a | |
Anticoagulant agents | 2540 (6.45) | 2476 (6.29) | 0.3504 |
Antihypertensive agents | 33,810 (85.89) | 33,608 (85.37) | 0.0401 |
Non-steroidal anti-inflammatory drugs | 26,634 (67.66) | 26,842 (68.19) | 0.1123 |
Selective serotonin reuptake inhibitors | 16,668 (42.34) | 17,038 (43.28) | 0.0077 |
Comorbidities | |||
Myocardial infarct | 2989 (7.59) | 3559 (9.04) | <0.0001 |
Congestive heart failure | 4509 (11.45) | 4774 (12.13) | 0.0034 |
Peripheral vascular disease | 1513 (3.84) | 1635 (4.15) | 0.0265 |
Cerebrovascular disease | 17,688 (44.93) | 18,451 (46.87) | <0.0001 |
Dementia | 1351 (3.43) | 1606 (4.08) | <0.0001 |
Chronic lung disease | 12,965 (32.93) | 13,507 (34.31) | <0.0001 |
Connective tissue disease | 998 (2.54) | 925 (2.35) | 0.0919 |
Ulcer | 14,147 (35.94) | 14,402 (36.58) | 0.0587 |
Chronic liver disease | 6403 (16.27) | 5883 (14.94) | <0.0001 |
Diabetes | 17,275 (43.88) | 17,524 (44.52) | 0.074 |
Diabetes with end organ damage | 6943 (17.64) | 7147 (18.16) | 0.0579 |
Hemiplegia | 602 (1.53) | 605 (1.54) | 0.9307 |
Moderate or severe kidney disease | 4055 (10.30) | 4276 (10.86) | 0.0105 |
Tumor, leukemia, lymphoma | 2626 (6.67) | 2608 (6.63) | 0.7968 |
Moderate or severe liver disease | 72 (0.18) | 73 (0.19) | 0.9338 |
Malignant tumor, metastasis | 319 (0.81) | 290 (0.74) | 0.2381 |
Acquired immunodeficiency syndrome | 3 (0.01) | 3 (0.01) | >0.9999 |
Intracerebral hemorrhage | 1238 (3.14) | 981 (2.49) | <0.0001 |
Death | 20,371 (51.75) | 17,620 (44.76) | <0.0001 |
Crude | p-Value | Adjusted | p-Value | |
---|---|---|---|---|
sHR a | sHR a | |||
Statin vs. non-statin | 0.74 (0.68–0.81) | <0.0001 | 0.74 (0.68–0.80) | <0.0001 |
Age | 1.00 (0.99–1.00) | 0.5141 | 1.00 (0.99–1.00) | 0.8965 |
Male vs. female | 1.07 (0.99–1.17) | 0.0963 | 1.07 (0.98–1.16) | 0.1395 |
Medication | ||||
Thrombolytic agents b | omitted | omitted | ||
Anticoagulant agents | 1.49 (1.28–1.72) | <0.0001 | 1.45 (1.24–1.70) | <0.0001 |
Antihypertensive agents | 1.04 (0.92–1.18) | 0.5109 | 1.03 (0.91–1.16) | 0.6602 |
Non-steroidal anti-inflammatory drugs | 0.87 (0.80–0.95) | 0.0024 | 0.92 (0.84–1.01) | 0.0992 |
Selective serotonin reuptake inhibitors | 0.96 (0.88–1.04) | 0.3179 | 0.98 (0.90–1.06) | 0.5854 |
Comorbidities | ||||
Myocardial infarct Congestive heart failure Peripheral vascular disease Cerebrovascular disease Dementia Chronic lung disease Connective tissue disease Ulcer Chronic liver disease Diabetes Diabetes with end organ damage Hemiplegia Moderate or severe kidney disease Tumor, leukemia, lymphoma Moderate or severe liver disease Malignant tumor, metastasis Acquired immunodeficiency syndrome c | 0.88 (0.74–1.04) 1.02 (0.88–1.17) 1.08 (0.87–1.36) 1.17 (1.07–1.27) 1.05 (0.82–1.34) 0.96 (0.88–1.05) 0.78 (0.57–1.07) 0.84 (0.77–0.92) 1.01 (0.90–1.14) 1.06 (0.97–1.15) 1.20 (1.08–1.34) 1.55 (1.15–2.07) 1.25 (1.09–1.43) 1.08 (0.91–1.29) 0.62 (0.16–2.48) 0.90 (0.50–1.62) NA c | 0.1209 0.8098 0.4771 0.0003 0.6939 0.3743 0.1210 0.0002 0.8096 0.1880 0.0009 0.0035 0.0014 0.3748 0.5016 0.7148 | 0.87 (0.73–1.04) 0.99 (0.85–1.15) 1.06 (0.84–1.32) 1.18 (1.08–1.28) 1.03 (0.81–1.33) 0.97 (0.89–1.07) 0.80 (0.59–1.10) 0.82 (0.74–0.90 1.03 (0.91–1.16) 1.00 (0.91–1.10) 1.19 (1.05–1.35) 1.45 (1.08–1.95) 1.24 (1.08–1.43) 1.11 (0.92–1.33) 0.65 (0.16–2.60) 0.83 (0.45–1.54) NA c | 0.1206 0.8657 0.6410 0.0002 0.7969 0.5991 0.1685 <.0001 0.6429 0.9809 0.0067 0.0126 0.0030 0.2748 0.5412 0.5590 |
Crude | p-Value | Adjusted | p-Value | |
---|---|---|---|---|
HRs a | HRs a | |||
Statin vs. non-statin | 0.81 (0.80–0.83) | <0.0001 | 0.75 (0.73–0.76) | <0.0001 |
Age | 1.07 (1.07–1.07) | <0.0001 | 1.07 (1.07–1.07) | <0.0001 |
Male vs. female | 1.01 (0.99–1.03) | 0.4933 | 1.28 (1.25–1.30) | <0.0001 |
Medication | ||||
Antithrombotic agents | 2.38 (0.90–6.34) | 0.0813 | 1.93 (0.72–5.14) | 0.1885 |
Anticoagulant agents | 1.14 (1.10–1.19) | <0.0001 | 1.03 (0.98–1.07) | 0.2420 |
Antihypertensive agents | 1.05 (1.02–1.08) | 0.0009 | 0.96 (0.94–0.99) | 0.0142 |
Non-steroidal anti-inflammatory drugs | 0.78 (0.76–0.79) | <0.0001 | 0.84 (0.82–0.86) | <0.0001 |
Selective serotonin reuptake inhibitors | 1.06 (1.04–1.09) | <0.0001 | 1.03 (1.01–1.05) | 0.0057 |
Comorbidities Myocardial infarct Congestive heart failure Peripheral vascular disease Cerebrovascular disease Dementia Chronic lung disease Connective tissue disease Ulcer Chronic liver disease Diabetes Diabetes with end organ damage Hemiplegia Moderate or severe kidney disease Tumor, leukemia, lymphoma Moderate or severe liver disease Malignant tumor, metastasis Acquired immunodeficiency syndrome | 1.49 (1.44–1.54) 1.96 (1.90–2.01) 1.61 (1.54–1.69) 1.29 (1.26–1.32) 2.21 (2.11–2.31) 1.36 (1.34–1.39) 1.16 (1.09–1.24) 1.21 (1.19–1.24) 1.01 (0.99–1.04) 1.54 (1.51–1.58) 1.74 (1.70–1.78) 1.52 (1.41–1.63) 1.91 (1.86–1.97) 1.66 (1.60–1.72) 1.90 (1.55–2.33) 2.19 (1.98–2.42) 0.93 (0.23–3.69) | <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.3458 <0.0001 <0.0001 <0.0001 <0.0001 <.00001 <0.0001 <0.0001 0.9124 | 1.11 (1.07–1.15) 1.39 (1.35–1.43) 1.21 (1.15–1.27) 1.05 (1.02–1.07) 1.24 (1.19–1.30) 0.98 (0.95-<1.00) 0.98 (0.92–1.04) 0.91 (0.89–0.93) 0.90 (0.88–0.93) 1.36 (1.33–1.40) 1.35 (1.31–1.39) 1.32 (1.22–1.41) 1.40 (1.36–1.45) 1.20 (1.15–1.25) 1.89 (1.54–2.31) 1.65 (1.49–1.83) 0.79 (0.20–3.17) | <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.0263 0.5019 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.7416 |
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Winardi, W.; Moi, S.-H.; Winardi, T.; Cheng, Y.-W.; Chen, P.-Y.; Lin, C.-K. Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan. Medicina 2024, 60, 939. https://doi.org/10.3390/medicina60060939
Winardi W, Moi S-H, Winardi T, Cheng Y-W, Chen P-Y, Lin C-K. Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan. Medicina. 2024; 60(6):939. https://doi.org/10.3390/medicina60060939
Chicago/Turabian StyleWinardi, William, Sin-Hua Moi, Thomas Winardi, Yu-Wen Cheng, Po-Yuan Chen, and Cheng-Kai Lin. 2024. "Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan" Medicina 60, no. 6: 939. https://doi.org/10.3390/medicina60060939