Statins' effect on quality of life and functioning in older stroke patients: Systematic review and meta-analysis

BACKGROUND: Limited evidence exists on the efficacy and safety of statins in older ischemic stroke or transient ischemic attack patients, particularly in frail individuals. Studies often exclude frail patients, limiting insights on optimal treatments for the entire older population. This review aims to evaluate the effect of statins for secondary prevention on quality of life and functioning in older patients following an ischemic stroke or transient ischemic attack, as these outcomes are aligned with the treatment goals of this patient population.

METHODS: We performed a systematic review and meta-analysis by searching four major databases up to June 6th, 2023. Studies were included if they involved statins, assessed quality of life or functioning, focused on older patients, and addressed ischemic stroke or transient ischemic attack.

FINDINGS: We included six randomized controlled trials and 16 cohort studies, totaling 66.273 patients. Mean or median age ranged from 65 to 79 years. Age ranges were not provided, and frailty status was not reported. One trial examined the effect of statins on QoL, yielding mixed results. Regarding the effect of statins on functioning, two trials reported positive effects, two found no effect, and two yielded mixed results. The meta-analysis of cohort studies indicated a positive association between statins and functioning (effect size: 0.43, CI 0.28-0.58). Methodological quality was poor, primarily due to confounding, participant selection and the allocation of patients into intervention groups.

CONCLUSION: We could not draw definitive conclusions regarding the effect of statins and QoL or functioning in older stroke patients. Mixed results were found in RCTs, and while a positive association between statins and functional outcome was observed in cohort studies, this should be interpreted with caution due to methodological limitations. Future research should focus on age-specific analyses and adequate representation of frail individuals to clarify this issue.