Statin Therapy After First Stroke Reduces Recurrence and Improves Mortality
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May 27, 2009 (Ioannina, Greece) — Statin therapy after a first stroke reduces the 10-year risk of recurrent stroke, a new study has shown [1]. Statin use also reduced the risk of mortality, even after adjustment for potential confounders, such as blood-pressure control, report investigators.
"Given the global burden of cerebrovascular disease, which affects almost all population groups, the potential benefits of statins cannot be overlooked," write Dr Haralampos Milionis (University of Ioannina School of Medicine, Greece) and colleagues in the May 26, 2009 issue of Neurology.
The new study, a retrospective observational analysis involving linked hospitalization and death records, included first-ever acute ischemic stroke patients from the Athenian Stroke Registry. The analysis includes a period, from January 1997 onward, during which poststroke statin therapy was not common practice.
The researchers note that since this time, there is now "compelling evidence from intervention trials in patients with coronary artery disease that statin treatment reduces stroke incidence." They point out, however, that risk factors for recurrent stroke "do not parallel those for first stroke," and data regarding the secondary prevention of stroke are lacking.
During follow-up of the 794 patients hospitalized for a first-time ischemic stroke, the recurrence rate was 14.1%. Of those stroke patients treated with a statin postdischarge, the recurrence rate was 7.6%, while the recurrence rate was 16.3% for those not treated with a statin. The median time to follow-up was 44 months for patients treated with statins and 40 months for those not receiving the lipid-lowering medication.
Regression analysis showed that only statin therapy prescribed after discharge from the index stroke event was an independent predictor of recurrent stroke. Statin therapy remained a strong predictor of long-term recurrence even after adjustment for the efficacy of control of blood pressure and lipid levels achieved 12 months after the index stroke.
Statin Therapy Postdischarge on Stroke Recurrence and Mortality Risk
| Statin therapy postdischarge | Hazard ratio (95% CI) |
| 1-y stroke recurrence | 0.61 (0.35–0.92) |
| Mortality | 0.22 (0.12–0.40) |
As estimated by the Kaplan-Meier method, patients on statins also had a significantly lower 10-year mortality risk after the first cerebrovascular event. Cox regression analysis showed that age, history of coronary and peripheral artery disease, atrial fibrillation, and heart failure were associated with an increased risk of death, while statin therapy was associated with a lower risk of all-cause mortality.
Milionis and colleagues note that the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study investigated cardiovascular end points, including recurrent stroke, in stroke patients, and that treatment with high-dose atorvastatin reduced the five-year risk of recurrence 16%. These results, despite benefits in men and women and the elderly and younger subgroups, are not generalizable, as SPARCL included only patients without cardiovascular disease and treated patients with the maximum statin dose. Their study, instead, suggests a drug class effect to prevent recurrence and improve mortality, suggest the investigators.
They add that hyperlipidemia was not a risk factor for stroke recurrence and mortality in the analysis, and this could be attributed to statins' cholesterol-independent effects, including various antithrombotic, antioxidative, anti-inflammatory, vasodilatory, and plaque-stabilizing mechanisms. Future studies, however, will need to fully explore the mechanism of benefit with statins in stroke.
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