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Pre-stroke use of statins on stroke outcome: a meta-analysis of observational studies.

BACKGROUND
Animal pre-clinical studies suggest that statins may have neuroprotective effects in acute ischaemic stroke. Statins might also increase the risk of developing haemorrhagic transformation after thrombolytic treatment.


METHODS
We performed a systematic review and included studies that compared good functional outcome, defined as a modified Rankin Scale (mRS) score < or = 2 at 3 months, in-hospital mortality and risk of symptomatic haemorrhagic transformation, between pre -stroke statin users and non users with acute ischaemic stroke.


RESULTS
Eleven studies met our predefined inclusion criteria. Statin therapy before stroke-onset was associated with a lower risk of in-hospital mortality (OR 0.56; 95% CI: 0.40 to 0.78, P < 0.0006). There was no difference between the two groups for good functional outcome at 3 months (OR 1.01; 95% CI: 0.64 to 1.61, P = 0.96). Statin use was associated with an increased risk of developing symptomatic haemorrhagic transformation after thrombolytic therapy (OR 2.34; 95% CI 1.31 to 4.17, P = 0.004).


CONCLUSIONS
Our meta-analysis suggests that pretreatment with statins does not improve 3 months functional outcome, defined as independence on mRS, but decreases in-hospital mortality and increases the risk of developing a symptomatic haemorrhagic transformation in patients treated with thrombolysis.