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| Statin treatment withdrawal in ischaemic stroke - a controlled randomised study |
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August 2007
Discontinuing statin treatment after a stroke is associated with an increased risk of death or dependency after 90 days, according to a study in the medical journal Neurology.
Recent reports suggest that statins, a popular class of cholesterol-lowering drugs, may protect the brain during the early phases of an ischaemic stroke.
Pretreatment with statins has been shown to reduce brain injury in cerebral ischaemia. This controlled randomised study investigated the influence of statin pretreatment and its withdrawal on the outcome of acute ischaemic stroke patients.
M. Blanco, MD, PhD, from the Department of Neurology, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain, and his colleagues gathered data from 215 patients admitted within 24 hours of a hemispheric ischaemic stroke, and 89 patients on chronic statin treatment were randomly assigned either to statin withdrawal for the first 3 days after admission (n = 46) or to immediately receive atorvastatin 20 mg/day (n = 43).
The primary outcome event was death or dependency (modified Rankin Scale [mRS] score > 2) at 3 months. Early neurologic deterioration (END) and infarct volume at days 4 to 7 were secondary outcome variables. In a secondary analysis, outcome variables were compared with the nonrandomised patients without previous statin therapy (n = 126).
The investigators found that patients with statin withdrawal showed a higher frequency of mRS score > 2 at the end of follow-up (60.0% vs 39.0%; p = 0.043), END (65.2% vs 20.9%; p < 0.0001), and greater infarct volume (74 [45, 126] vs 26 [12, 70] mL; p = 0.002) compared with the non-statin-withdrawal group. Statin withdrawal was associated with a 4.66-fold (1.46 to 14.91) increase in the risk of death or dependency, an 8.67-fold (3.05 to 24.63) increase in the risk of END, and an increase in mean infarct volume of 37.63 mL (SE 10.01; p < 0.001) after adjusting for age and baseline stroke severity. Compared with patients without previous treatment with statins, statin withdrawal was associated with a 19.01--fold (1.96 to 184.09) increase in the risk of END and an increase in mean infarct volume of 43.51 mL (SE 21.91; p = 0.048).
The authors concluded that the findings suggest that after an ischaemic stroke the protective effects of previous statin therapy on the brain disappear if the drug is withdrawn.
"Our findings strongly support that previous statin therapy should not be interrupted during the acute phase of ischaemic stroke."
Reference:
Neurologe 2007; 69 (9): 904–910.
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