Statins may provide additional poststroke survival benefit in those with prior cancer
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Statin therapy after ischemic stroke is associated with improved survival and may be particularly beneficial in patients with a history of cancer, according to a brief report published in Stroke.
“Statins improve survival in people with stroke of atherosclerotic origin. Statins also have other therapeutic benefits that are not cholesterol-related, often called pleiotropic effects, including anticancer, anti-inflammatory, antioxidative, antiproliferative and plaque stabilizing effects,” Muideen T. Olaiya, PhD, postdoctoral researcher in the translational public health division of the stroke and aging research group in the School of Clinical Sciences at Monash Health, Monash University, and colleagues wrote. “These anticancer effects are thought to be through mechanisms, such as antiproliferation, proapoptosis, and migration and invasion inhibition. However, it is unclear whether statins confer additional benefits for survivors of stroke with a history of cancer.”
To evaluate the relationship between poststroke statin initiation and survival in patients with and without a history of cancer, researchers conducted a retrospective cohort study of 9,948 patients from the Australian Stroke Clinical Registry with ischemic stroke admitted at 48 hospitals across Victoria and Queensland, Australia (median age, 72 years; 42% women).
Pharmaceutical records were used to determine dispense of statin therapy within 91 days after hospital discharge. History of cancer was identified using in-hospital records.
Patients admitted from 2012 to 2016 were followed up until death or June 30, 2018, whichever occurred first.
At 91 days, 82% of the cohort had received statin therapy, and during a median of 2.7 years, there were 1,463 deaths.
Compared with dispense of statin therapy within 91 days, no dispense was associated with increased risk for mortality after ischemic stroke among patients with no history of cancer (adjusted HR = 1.66; 95% CI, 1.37-2); however, risk was even greater in patients with a history of cancer and no dispense of statin therapy (aHR = 2.17; 95% CI, 1.53-3.1; relative excess risk due to interaction, 2.8; 95% CI, 1.56-5.05; attributable proportion due to interaction, 0.45; 95% CI, 0.23-0.66; synergy index, 2.14; 95% CI, 1.32-3.49).
Moreover, the joint effect of not being dispensed statin therapy and having a history of cancer was greater compared with their individual effects on risk for mortality after ischemic stroke, according to the study.
“Being dispensed statins after ischemic stroke may confer additional survival benefits in those with history of cancer than in those without,” the researchers wrote. “Given that having a history of cancer confers greater risks of recurrent stroke or mortality poststroke, prescribing statins for secondary prevention may improve survival in people with ischemic stroke who have had cancer. Our findings warrant further investigation in randomized clinical trials.”
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