SAT-264 Association of Low-to-Moderate vs. High Intensity Statins with Secondary Cardiovascular Outcomes After Ischemic Stroke: A Nationwide Cohort Study

Abstract Disclosure: K. Kim: None. J. Choi: None. K. Kim: None. S. Kim: None. The optimal statin intensity for secondary stroke prevention in Asian populations remains unclear. Despite guideline recommendations for intensive LDL-C lowering, evidence in Asians is limited. Given the lower incidence of ischemic cardiovascular disease and stroke compared to Western populations, the necessity of high-intensity therapy and its potential adverse effects warrant further investigation. This study aimed to assess the association between statin intensity and cardiovascular outcomes in statin-naïve stroke patients, focusing on baseline LDL-C levels.This retrospective cohort study used the Korean National Health Insurance Service (NHIS) database. Patients diagnosed with ischemic stroke (ICD-10 I63) who underwent brain imaging within 7 days before or 2 days after hospitalization and initiated statin therapy were identified (N=93,333). After excluding patients with prior statin use, late initiation, short treatment duration, and missing LDL-C data, 5,947 low-to-moderate intensity and 2,332 high-intensity statin users remained. Propensity score matching weights resulted in 2,149 patients in the low-to-moderate intensity group and 2,144 in the high-intensity group. The primary outcome was major cardiovascular events (MACE), and the secondary outcome was all-cause mortality, with subgroup analyses based on baseline LDL-C levels and clinical characteristics.After propensity score matching weights, a total of 4,293 patients were included (low-to-moderate intensity: 2,149; high-intensity: 2,144). Baseline characteristics were well balanced between the two groups, with no significant differences in age (63.1 ± 6.4 years), sex (75.7% male), BMI (25.2 ± 2.5 kg/m²), comorbidities, or concurrent medication use (all ASD < 0.1). The median time from stroke diagnosis to statin initiation was 1 day in both groups. LDL-C levels at baseline were similar (122.5 ± 20.1 mg/dL vs. 122.3 ± 31.7 mg/dL, ASD = 0.007). There was no significant difference in major cardiovascular events (MACE) between the two statin intensity groups (HR = 1.13, 95% CI: 0.92–1.38, p = 0.249). However, in patients with baseline LDL-C ≥100 mg/dL, high-intensity statin therapy was associated with a significant reduction in all-cause mortality (HR = 0.77, 95% CI: 0.60–0.98, p = 0.037). Subgroup analysis showed no significant statistical interactions (interaction p-value < 0.05) between statin intensity and major cardiovascular events across various demographic and clinical characteristics.This study evaluates the necessity of high-intensity statins for secondary stroke prevention in Asian patients. While no significant difference in MACE was found, survival benefits were observed in those with baseline LDL-C ≥100 mg/dL, emphasizing the need for personalized treatment based on LDL-C levels and patient characteristics. Presentation: Saturday, July 12, 2025