The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

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OBJECTIVE

Cerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.

METHODS

This was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.

RESULTS

A total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).

CONCLUSIONS

Consistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

ABBREVIATIONS CI = confidence interval; DM = diabetes mellitus; HR = hazard ratio; ICD-10 = International Classification of Diseases, 10th revision; MI = myocardial infarction; MMP = matrix metalloproteinase; NHIS = National Health Insurance Service; NHIS-NSC = NHIS–National Sample Cohort; PDC = proportion of days covered; SAH = subarachnoid hemorrhage.

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  • Supplemental Table S1 (PDF 157 KB)

Article Information

Correspondence Jinkwon Kim: Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. antithrombus@gmail.com; antithrombus@yuhs.ac.

INCLUDE WHEN CITING Published online May 24, 2019; DOI: 10.3171/2019.3.JNS183500.

T.J.S. and S.H.O. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Flowchart of patient selection for this study. NHIS-NSC indicates National Health Insurance Service–National Sample Cohort in Korea.

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