Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer

被引：32

作者：

Addison, Daniel ^{[1
,2
,3
,4
]}

Lawler, Patrick R. ^{[5
,6
,7
]}

Emami, Hamed ^{[1
,3
]}

Janjua, Sumbal A. ^{[1
]}

Staziaki, Pedro V. ^{[1
]}

Hallett, Travis R. ^{[1
]}

Hennessy, Orla ^{[1
]}

Lee, Hang ^{[8
]}

Szilveszter, Balint ^{[1
]}

Lu, Michael ^{[1
]}

Mousavi, Negar ^{[7
]}

Nayor, Matthew G. ^{[7
]}

Delling, Francesca N. ^{[9
]}

Romero, Javier M. ^{[10
]}

Wirth, Lori J. ^{[11
]}

Chan, Annie W. ^{[12
]}

Hoffmann, Udo ^{[1
]}

Neilan, Tomas G. ^{[1
,2
,3
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Cardiac MR PET CT Program, 165 Cambridge St, Boston, MA 02114 USA

[2] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Cardiooncol Program,Div Cardiol, 165 Cambridge St, Boston, MA 02114 USA

[3] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Div Cardiol, Boston, MA 02114 USA

[4] Ohio State Univ, Dept Med, Div Cardiol, Columbus, OH 43210 USA

[5] Univ Toronto, Toronto Gen Hosp, Peter Munk Cardiac Ctr, Toronto, ON, Canada

[6] Univ Toronto, Heart & Stroke Richard Lewar Ctr Excellence, Toronto, ON, Canada

[7] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Div Cardiol, Boston, MA 02114 USA

[8] Harvard Med Sch, Massachusetts Gen Hosp, Biostat Ctr, Dept Med, Boston, MA 02114 USA

[9] Univ Calif San Francisco, Dept Med, Div Cardiol, San Francisco, CA USA

[10] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Div Neuroradiol, Boston, MA 02114 USA

[11] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Div Oncol, Boston, MA 02114 USA

[12] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA

来源：

JOURNAL OF STROKE | 2018年 / 20卷 / 01期

基金：

美国国家卫生研究院;

关键词：

Radiation; Radiotherapy; Hydroxymethylglutaryl-CoA reductase inhibitors; Cerebrovascular events; Stroke; Ischemic attack; transient; HEALTH-CARE PROFESSIONALS; CAROTID-ARTERY STENOSIS; C-REACTIVE PROTEIN; RADIATION-THERAPY; PRIMARY PREVENTION; X-RAY; IRRADIATION; STATEMENT; CORONARY; SURGERY;

D O I：

10.5853/jos.2017.01802

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. Among broad populations, statins reduce CVEs; however, whether statins reduce CVEs after RT for HNCA is unclear. Therefore, we aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA. Methods From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors. Results The final cohort consisted of 1,011 patients (59 +/- 13 years, 30% female, 44% hypertension) with 288 (28%) on statins. Over a median follow-up of 3.4 years (interquartile range, 0.1 to 14) there were 102 CVEs (89 ischemic strokes and 13 TIAs) with 17 in statin users versus 85 in non-statins users. In a multivariable model containing known predictors of CVE, statins were associated with a reduction in the combination of stroke and TIA (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2 to 0.8; P=0.01) and ischemic stroke alone (HR, 0.4; 95% CI, 0.2 to 0.8; P=0.01). Conclusions Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.

引用

页码：71 / +

页数：13