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Discontinued statin use after stroke linked with increased mortality
Many patients end statin regimens shortly after acute strokes.
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Researchers have found that many patients discontinue long-term statin therapy after ischemic stroke.
Results from the study, published in Stroke, also reported a link between the discontinuation of these regimens and higher mortality.
“Results from several recent studies have shown that both discontinuation and reduced adherence to prescribed statin treatments are associated with a negative effect on clinical outcome in patients with a recent acute coronary syndrome,” Furio Colivicchi, MD, cardiologist at the San Filippo Neri Hospital, Rome, said in an interview. “In particular, patients discontinuing statins after an acute MI usually show an increased mortality.”
The study population included 631 acute ischemic stroke survivors (322 men and 309 women) who were treated with statins and had no prior reported histories of CHD. The patients had been discharged from San Filippo Neri Hospital between 2000 and 2005 and were followed for 12 months after acute ischemic stroke. The primary endpoint for the patient population was all-cause mortality.
Women, elderly
Colivicchi and colleagues reported that 246 patients discontinued their statin therapy within 12 months of acute ischemic stroke, with a mean time from discharge to discontinuation of statins of 48.6 days. Of those 246 patients, 116 died.
According to the researchers, multivariate analysis determined that statin therapy discontinuation was an independent predictor of all-cause mortality at one year and that the overall one-year probability of death among the patient population was 0.18. Multivariate analysis also showed that older patients and women (were more likely to discontinue statin therapy. Patients with diabetes were more likely to continue statin therapy after ischemic stroke.
“All patients with cardiovascular disease should carefully adhere to prescribed medical treatments,” Colivicchi said. “All evidence-based treatments, including statins, should never be discontinued without specific clinical reasons. Moreover, the decision to withdraw a pharmacological treatment should always be taken by the physician in charge of the patient.”
The researchers concluded that even after adjusting for variables like age, sex, clinical history and chronic lung disease, discontinuing statin therapy was associated with all-cause mortality at one year. Findings from previous studies demonstrated a link between statin therapy discontinuation and mortality in patients with CHD, but results from this recent study revealed an additional dimension.
“Our study is the first one to show that even in ischemic stroke survivors without clinical evidence of CAD, discontinuation of statin therapy doubles the risk of premature death,” Colivicchi said. “This result is in keeping with all previous investigations showing that patients with atherosclerotic vascular disease should never discontinue statin therapy.” - by Eric Raible
This article adds to the growing body of evidence that all patients with atherosclerotic vascular disease should be on statin therapy and should not stop unless there is a compelling reason. Prior studies have shown that statins decrease the risk of cardiovascular events after a stroke. It is important for all patients with CHD or cerebrovascular disease to remain on effective antiplatelet therapy, BP control, and cholesterol management and to try to optimize their dietary and exercise habits.
— Roger S. Blumenthal, MD
For more information:
- Colivicchi F, Bassi A, Santini M, Caltagirone C. Discontinuation of statin therapy and clinical outcome after acute ischemic stroke. Stroke. 2007;doi.org/10.1161/stroke.aha.107.487017. Accessed on Aug. 29, 2007.