MONDAY, May 25, 2009 (HealthDay News) -- Taking a cholesterol-lowering statin after a stroke reduces the risk of a second stroke, new research shows.
The 10-year study of nearly 800 people who had strokes found a 35 percent lower incidence of second strokes and a 57 percent lower death rate among those who took statins compared to those who didn't, according to a report in the May 26 issue of Neurology.
Statins include blockbuster medications such as Crestor, Lipitor, Pravachol and Zocor.
The new Greek study echoes findings from an even bigger international trial, reported in 2006, called Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL).
Together, "our study and the SPARCL study have clearly shown the benefits of statins," said Dr. Sotirios Giannopolous, assistant professor of neurology at the University of Ioannina, Greece, and lead author of the new trial.
SPARCL involved more than 4,700 individuals treated for strokes or "mini-strokes" (formally called transient ischemic attacks) at 205 medical centers around the world. It found a 16 percent reduction in second strokes, as well as a 35 percent reduction in major coronary events among participants given 80 milligrams a day of a single statin, Lipitor.
In the new Greek study, Giannopolous' team found that about 8 percent of those on statins had a second stroke, compared to 16 percent of participants not taking the medications.
The new study rounded out the SPARCL results because "we have included all statins in all dosages, thus our study reveals the drug class effect," Giannopoulos said. Based on the findings, "I would recommend administration of a statin on admission to a hospital," he said.
But Giannopoulos stressed that the cholesterol-lowering activity of a statin may not be the prime cause of related reductions in stroke. "Statins have anti-inflammatory and antioxidative effects," he said, "and [they] also prevent blood clotting and stabilize plaque in the arteries. So, one of these mechanisms may help to prevent recurrent stroke."
Reports that statins can help prevent stroke recurrence are already affecting medical practice, he said. "It is almost policy here in the United States to start statin therapy after stroke, even in patients with normal cholesterol levels," Giannopoulos said.
That is true to some extent, added Dr. Gary Abrams, an associate professor of neurology at the University of California, San Francisco.
Statins are "regularly used, certainly, by stroke experts," Abrams said. "It is unclear how well it is permeating the general medical community, but as the evidence unfolds I believe use will be more widespread."
While the Greek study has "a lot of useful information, it has certain weaknesses," Abrams said. "It doesn't really provide information about which statin to use and it doesn't provide information about dosages."
But there's no clear evidence that one statin is better than another, anyway, Abrams said. "My belief is that probably any statin is better than none at all," he said. "In terms of dosage, you have to target that to certain lipid [cholesterol] levels. Which statin? That question is still open."
Abrams agreed that the exact mechanism of action is unclear. "It depends partly on lipid-lowering, partly from reducing inflammation and partly from the direct effect on blood vessels," he theorized.
More information
There's more on stroke treatment at the American Heart Association.
SOURCES: Sotirios Giannopoulos, M.D., assistant professor, neurology, University of Ioannina, Greece; Gary Abrams, M.D., associate professor, neurology, University of California, San Francisco; May 26, 2009, Neurology
Objective: To determine whether statin therapy after hospital discharge affects ischemic stroke recurrence and long-term mortality in patients admitted for a first-ever occurrence of ischemic stroke.
Methods: This was a retrospective observational study involving linked hospitalization and death records. The cohort comprised a series of 794 consecutive, first-ever acute ischemic stroke patients from the Athenian Stroke Registry, admitted to the acute stroke unit and the general medicine and neurology ward of our institutions since January 1997 for whom there was available information covering a 10-year follow-up period. Cox proportional hazards model was used to identify risk factors for stroke recurrence and death.
Results: The recurrence rate was 16.3% among stroke patients not receiving a statin after hospital discharge compared with 7.5% among those who received statin therapy (p = 0.002). Cox regression analyses revealed only statin therapy postdischarge to be a significant independent predictor of stroke recurrence (adjusted hazard ratio [HR], 0.65, 95% confidence interval [CI] 0.39 to 0.97, p < 0.01). Similarly, patients receiving a statin had a significantly lower mortality during the 10-year period after the acute cerebrovascular event (adjusted HR, 0.43; 95% CI 0.29 to 0.61, p < 0.01).
Conclusions: Prescribing statin therapy upon hospital discharge to patients with first-ever acute stroke lowers the risk of 10-year stroke recurrence and improves survival.
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