The Effect of Statins on Acute and Long-Term Outcome After Ischemic Stroke in the Elderly Clara Hjalmarsson, PhD 1,2 ; Lena Bokemark, PhD 1,2 ; Karin Manhem, PhD 1 ; Kirsten Mehlig, PhD 3 ; and Björn Andersson, PhD 1,2 1 The Stroke Unit, Sahlgrenska University Hospital, Göteborg, Sweden; 2 Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden; and 3 Department of Community Medicine and Public Health, Institute of Medicine, Göteborg University, Göteborg, Sweden ABSTRACT Background: Although treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke. Objective: The aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population. Methods: We investigated the association between previous statin use and stroke severity (National Institutes of Health Stroke Scale [NIHSS]), as well as the effect of poststroke statin treatment on 12-month functional outcome (modified Rankin Scale [mRS] score) in 799 patients (mean age, 78 years), with acute ischemic stroke. The effect of statin treatment on survival was examined using the Cox proportional hazard model, after adjusting for relevant covariates. Results: Statins did not decrease stroke severity and did not improve 30-day survival. However, both the 12-month survival (hazard ratio = 0.33; 95% CI, 0.20 –to 0.54; P  0.001) and the 12-month functional outcome (odds ratio = 2.09; 95% CI, 1.25–3.52; P = 0.005) were significantly better in the group treated with statins. Conclusions: Significantly better survival and functional outcome were noted with poststroke statins at the end of the 12-month follow-up period. Statins seem to provide beneficial effects for the long-term functional outcome and survival in the elderly. (Am J Geriatr Pharmacother. 2012;10:313–322) © 2012 Elsevier HS Journals, Inc. All rights reserved. Key words: ischemic stroke, lipids, low-density lipoprotein, statins, stroke prognosis. INTRODUCTION Stroke is one of the leading causes of chronic disability and death worldwide, with the incidence progres- sively increasing with age. The overall risk of recurrent stroke, fatal or nonfatal, is 20% at 5 years. 1 Also, cardiac events increase after stroke and are the major cause of mortality. 1 In several trials, statins have been shown to reduce the risk of having a first or recurrent ischemic stroke. 2–4 The prophylactic actions of statins in patients with or with- out ischemic heart disease have been mainly explained by the lipid-lowering effect theory, 5 although benefits have been noted even when the reduction in lipid levels was modest. The magnitude of the benefits might be primarily related to individuals’ overall risk of major vas- cular events and, ultimately, to age and comorbidity rather than to their blood lipid level alone. 6 Substantial evidence from randomized trials shows that statins re- duce total stroke rates in patients with a wide range of ages and blood pressures, 7,8 largely irrespective of pre- vious vascular disease, sex, or baseline low-density lipo- protein (LDL) cholesterol. 9,10 Although the effect of statins on the incidence of re- current stroke is quite clear, less is known about their effect on mortality and functional outcome after stroke, specifically in older patients. In experimental models of acute ischemic stroke, early treatment, as well as pretreatment, with statins seems to reduce the infarct volume 11–14 and the degree of neuro- logic disability. 12,15,16 It has been postulated that the acute protective effects would be mediated through enhanced angiogenesis, synaptogenesis, and neuronal Accepted for publication September 5, 2012. http://dx.doi.org/10.1016/j.amjopharm.2012.09.001 © 2012 Elsevier HS Journals, Inc. All rights reserved. 1543-5946/$ - see front matter C. Hjalmarsson et al. The American Journal of Geriatric Pharmacotherapy Volume 10 ● Number 5 October 2012 313