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Aims: To examine the association between statin use before and after intracranial haemorrhage (ICH) and the risk of poststroke epilepsy (PSE). Methods: Patients with new‐onset ICH between 2004 and 2012 were identified from the Taiwan National Health Insurance Research Database. The main outcome was the occurrence of epilepsy after stroke. Multivariable Cox regression modelling was used to estimate the association between statin use and the risk of PSE, with poststroke medication exposures being treated as time‐dependent variables. Results: A total of 7435 patients with ICH were enrolled with a median follow‐up of 17.6 months. Within the study cohort, 709 patients developed PSE. Poststroke, but not prestroke, stain use was associated with a reduced risk of PSE (adjusted hazard ratio 0.62, 95% confidence interval 0.42–0.90, P = 0.01). In subanalyses, a trend of a dose–response relationship was observed. A significant PSE risk reduction was correlated with a higher cumulative statin dose. Moreover, the risk of PSE was lower in patients receiving moderate‐to‐high‐intensity statin therapy (adjusted hazard ratio 0.37, 95% confidence interval 0.18–0.75, P = 0.01). Lipophilic and hydrophilic statins were similar with regard to their associations with the reduced risk of PSE. Conclusions: Statin therapy may reduce the risk of PSE after ICH, especially with moderate‐to‐high therapy intensity. Further research is needed to understand the mechanisms underlying the potential protective effects of statins against PSE in this patient population. [ABSTRACT FROM AUTHOR]

Objective: Whether a low-density lipoprotein cholesterol (LDL-C) goal is essential in secondary prevention is still being debated. The aim of our study was to investigate whether achieving particular LDL-C level goals is associated with the reduction in the risk of major adverse cardiac events (MACEs) in patients with atherosclerotic cardiovascular diseases (ASCVD) on statin therapy. Methods and results: From January 2010 to August 2014, a total of 4099 patients with ASCVD in the Taiwan Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) registry were analyzed. The risk of a MACE was lower in patients with LDL-C level under control at < 100 mg/dL by statins than in patients with LDL-C level ≥100 mg/dL whether on statin therapy (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.04‒2.63, p = 0.03) or not (HR 2.04, 95% CI 1.06‒3.94, p = 0.03). In multivariate Cox model analyses, statin intensity had no significant predictive value, and LDL-C ≥ 100 mg/dL was associated with a slight but not significant trend toward increased risk of MACEs (HR 1.41, 95% CI 0.96‒2.07, p = 0.08). Conclusions: For patients with ASCVD on statin therapy guided by a target-driven strategy, failure to control LDL-C levels to < 100 mg/dL was associated with higher risk of MACEs. Statin intensity alone had no significant impact on the risk of MACEs after multivariate adjustment. [ABSTRACT FROM AUTHOR]

Population aging is a global trend, and the elderly have a higher risk of atherosclerotic cardiovascular disease (ASCVD) and related mortality. Statins have been observed to reduce cardiovascular events in patients with ASCVD. However, compared with secondary prevention, the benefits of statins for primary prevention are undetermined among the elderly. This study aimed to evaluate the effectiveness of statins in an elderly population without a history of cardiovascular disease (CVD). The study was carried out using the National Taiwan University Hospital Integrated Medical Database and the National Health Insurance Research Database in Taiwan. Patients aged 65 years and older without a history of CVD were identified between 1 February 2008 and 31 December 2015. New statin users were 1:4 matched to nonusers based on certain variables. The risks of major adverse cardiovascular events (MACEs) and all-cause mortality were estimated using Cox proportional hazards models. Further, we applied marginal structural models to account for time-varying low-density lipoprotein cholesterol (LDL-C) levels. A total of 2761 new statin users and 9503 nonusers were selected after matching; the mean age was 71.8 years, and 63% were women. At a median follow-up of 4.8 years, statin use was associated with reduced risk of MACEs (hazard ratio [HR]: 0.75; 95% confidence interval [CI], 0.52–0.98) and mortality (HR: 0.72, 95% CI: 0.55–0.93) when accounting for time-varying LDL-C. No significant differences in effect were detected between subgroups. Statin use could be beneficial for the primary prevention of CVD in elderly Asians. • Statin therapy could be beneficial for primary prevention of cardiovascular disease in elderly Asians. • Compared with statin non-users, statin users had significantly lower risks of MACE and all-cause mortality. • The assessment was confirmed by marginal structural models to adjust for confounding effect of time-varying LDL-C levels. [ABSTRACT FROM AUTHOR]

Background: Low HDL-C is a common lipid phenotype in Asia. Although low HDL-C is a risk factor of atherosclerotic cardiovascular disease (ASCVD) in general population, it is controversial whether the on-treatment HDL-C level is still a predicting factor of cardiovascular (CV) events in ASCVD patients (pts) under statin treatment. Methods and Results: A total of 3,731 pts (age 65.6 yrs, 75% men) receiving statins were selected from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry, a multicenter, observational study of adult pts with stable coronary artery disease (CAD), cerebrovascular disease, or peripheral arterial disease in Taiwan. Low HDL-C was defined as < 40 mg/dL for male and < 50 mg/dL for female. The pts with low HDL-C (44%, mean HDL-C 34.9 ± 6.8 mg/dL) during statin treatment were younger and with more female, diabetes, CAD and higher body weight than pts with normal HDL-C. The primary outcome was a composite CV events including CV death, myocardial infarction (MI), stroke or cardiac arrest with resuscitation. The mean follow-up time was 2.7 years. Multivariate Cox proportional hazard analysis showed on-treatment low HDL-C was not an independent risk factor of primary outcome (normal vs. low HDL-C, hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.55-1.20) after adjusting multiple clinical factors. The risk of CV events was recalculated for each quintile of HDL-C. In the univariate model, the CV event rate decreased progressively by 23% from the lowest (< 35 mg/dL) to the highest (> 54 mg/dL) quintile of HDL-C. However, multivariate Cox proportional hazard analysis showed no significant relationships between quintiles of HDL-C levels and the risk of CV events (HDL-C < 35 [HR 1.50, 95% CI 0.82-2.76], 35 to 40.2 [HR 0.99, 95% CI 0.52-1.88], 40.2 to <46 [HR 1.07, 95% CI 0.58-1.99], 46 to < 54 [HR 1.09, 95% CI 0.59-2.01] vs. >54 mg/dL). Conclusions: In Taiwanese pts with ASCVD under statin therapy, low on-treatment HDL-C was not associated with increased risk of CV events. [ABSTRACT FROM AUTHOR]