Assessment of Recurrent Ischemic Stroke Risk Among the First Ever Stroke Patients Using Hypolipidemic Drugs

• Main Authors: CHEN, KAN-HENG, 陳侃亨
• Other Authors: HU, MING-KUAN
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/93fbmd

碩士 === 國防醫學院 === 藥學研究所 === 107 === Background: Brain stroke is a very prevalent disease in developed countries. Among the top ten causes of death in Taiwan, cerebrovascular disease ranked fourth in 2017. Statistics show that the incidence of stroke is about three-thousandths. About three-quarters of them are ischemic strokes; according to the World Health Organization, a total of 15.2 million deaths were caused in 2016, which is a highly prevalent disease. There are many reasons for the occurrence of stroke. Many times, it has a lot to do with life style. It relates to hyperlipidemia caused by high fat dietary habits. Therefore, controlling hyperlipidemia is a very important key. At present, the more commonly used drugs for lowering blood lipid are statins and non-statin lipid lowering medication(fibrates), which can effectively control blood lipids to avoid vascular occlusion, and statins can effectively prevent people from occurrence of stroke. However, considering the health insurance differs among a variety of statins, and the efficacy of statins relatively lacks for local investigation, what’s more, the lack of comparison between statins and fibrates matters as well. Therefore, it is particularly important to compare the risk of re-hospitalization of ischemic stroke after taking the prescribed. Method: This study is a retrospective cohort study, with data provided by National Health Insurance Administrations 2005-2010 national health insurance claim data for the entire population. The patients of this period from 2005 to 2010 were diagnosed hyperlipidemia, they had have been hospitalized for the first time due to ischemic stroke, and had taken a single lipid-lowering drug over 90 days, more than one year had they been tracked. Exclusion criteria were those who were hospitalized because of car accidents, were younger than 45 years old, and died of illness and suicide. The primary outcome of rehospitalization is aimed at ischemic stroke. This study used cumulative hazard ratios to analyze the results. Result: 9098 people in total were included in the analysis, with 8016 in the statins group and 1082 in the non-statin lipid lowering medication(fibrates) group. The number of patients using high intensity statin was 6479, the number of patients using low intensity statin was 1537, the number of patients with diabetes was 3080, and the number of heart failure was 661. The number of patients with re-ischemic stroke in the statin group was 477, and in the non-statin lipid lowering medication group was 91. In the COX model regression analysis (95% confidence interval, p value), the adjusted hazard ratios of the non-statin lipid lowering medication to the low intensity statin group was 1.32(0.96-1.79, p=0.054) for the re-ischemic stroke, the risk ratio of rosuvastatin to atorvastatin was 0.64 (0.50-0.87, p=0.001) for the re-ischemic stroke, and the risk ratio for simvastatin was 1.07 (0.75-1.36, p=0.608); according to the studies of hypolipidemic drugs, rosuvastatin has the best effect, whose p value of 0.001 was statistically significant. Conclusion: This study revealed that there are trending statins better than fibrates to prevent patients from rehospitalization of ischemic stroke. Of all statins, rosuvastatin contains a lower risk when compared with atorvastatin.