Yet you seem to recommend high dose statins even though the FDA suggests they not be prescribed anymore from 8 years ago. How out of date are you? And you still have a job?
FDA announces new safety recommendations for high-dose simvastatin June 2011
Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis
- Irene TramacereEmail author,
- Giorgio B. Boncoraglio,
- Rita Banzi,
- Cinzia Del Giovane,
- Koren H. Kwag,
- Alessandro Squizzato and
- Lorenzo Moja
- Received: 18 October 2018
- Accepted: 5 March 2019
- Published: 26 March 2019
Abstract
Background
Statins may prevent recurrent
ischemic events after ischemic stroke. Determining which statin to use
remains controversial. We aimed to summarize the evidence for the use of
statins in secondary prevention for patients with ischemic stroke by
comparing benefits and harms of various statins.
Methods
We searched for randomized
controlled trials (RCTs) assessing statins in patients with ischemic
stroke or transient ischemic attack (TIA) in MEDLINE, EMBASE, and
CENTRAL up to July 2017. Two authors extracted data and appraised risks
of bias. We performed pairwise meta-analyses and trial sequential
analyses (TSA) to compare statins versus placebo/no statin, and network
meta-analyses using frequentist random-effects models to compare statins
through indirect evidence. We used GRADE to rate the overall certainty
of evidence. Primary outcomes were all-cause mortality and all strokes.
Secondary outcomes were different types of strokes, cardiovascular
events, and adverse events.
Results
We identified nine trials
(10,741 patients). No head-to-head RCTs were found. The median follow-up
period was 2.5 years. Statins did not seem to modify all stroke and
all-cause mortality outcomes; they were associated with a decreased risk
of ischemic stroke (odds ratio, OR, 0.81 [95% CI, 0.70 to 0.93];
absolute risk difference, ARD, − 1.6% [95% CI, − 2.6 to − 0.6%]),
ischemic stroke or TIA (OR, 0.75 [95% CI, 0.64 to 0.87]; ARD, − 4.2%
[95% CI, − 6.2 to − 2.1%]), and cardiovascular event (OR, 0.75 [95% CI,
0.69 to 0.83]; ARD, − 5.4% [95% CI, − 6.8 to − 3.6%]), and did not seem
to modify rhabdomyolysis, myalgia, or rise in creatine kinase. In the
comparison of different statins, moderate- to high-quality evidence
indicated that differences between pharmaceutical products seemed
modest, with high doses (e.g., atorvastatin 80 mg/day and simvastatin
40 mg/day) associated with the greatest benefits. TSA excluded random
error as a cause of the findings for ischemic stroke and cardiovascular
event outcomes. Evidence for increased risk of hemorrhagic stroke was
sensitive to the exclusion of the SPARCL trial.
Conclusions
Evidence strongly suggests
that statins are associated with a reduction in the absolute risk of
ischemic strokes and cardiovascular events. Differences in effects among
statins were modest, signaling potential therapeutic equivalence.
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