Statin initiation despite already low LDL tied to improved mortality after first stroke
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Key takeaways:
- In-hospital initiation of statin therapy may lower all-cause death risk in patients with first-time stroke and already low LDL.
- Statins did not appear to impact risk for secondary stroke or MI.
Researchers in South Korea showed that statin therapy for treatment-naive patients with already low LDL hospitalized for first-time stroke may reduce risk for all-cause death in the following months.
Statin therapy did not affect risk for secondary stroke or MI, according to data published in the Journal of the American Heart Association.
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“A target LDL-C level < 70 mg/dL is recommended to reduce the risk of vascular events in acute ischemic stroke,” Joon-Tae Kim, MD, PhD, of the department of neurology at Chonnam National University Medical School, Chonnam National University Hospital in Gwangju, South Korea, and colleagues wrote. “However, an issue that still needs further research is whether statin treatment could reduce the risk of early vascular events when baseline LDL-C levels are already low, at < 70 mg/dL, at the time of index stroke.”
For this prospective, multicenter study of the nationwide Clinical Research Center for Stroke-Korea registry, researchers assessed 2,850 consecutive patients with first-time acute ischemic stroke and LDL less than 70 mg/dL at baseline without prior statin treatment (mean age, 70 years; 64% men).
The primary outcome was a composite of hemorrhagic or ischemic stroke, MI and all-cause death within 3 months of hospitalization.
Overall, 74.2% of patients with already low LDL received statin therapy during hospitalization for first-time stroke.
The primary composite outcome occurred in 6.7% patients who received statin therapy compared with 21.5% of patients who did not (P < .001), according to the study. After inverse probability of treatment weighting, the rates of the primary composite outcome were 7.64% in the statin group and 13.13% in the no statin group (P < .001), and statin therapy was associated with a nearly 50% reduction in the primary composite outcome (HR = 0.54; 95% CI, 0.42-0.69).
The reduction in occurrence of the primary outcome was mainly driven by lower mean event rates at 3 months for all-cause death (5.51% vs. 12.13%; P < .001) while the rates of stroke (P = .692), hemorrhagic stroke (P = .885) and MI (P = .263) were not significantly different.
“Statins seemed to have considerable effectiveness in reducing the risk of early vascular outcomes, mainly death, which might be related to the pleiotropic effect of statins,” the researchers wrote. “These might include neuroprotection, improved collateral flows, and anti-inflammatory effects, but their effect in reducing the risk of recurrent stroke by reducing atherothrombosis is less substantial in the early periods after acute ischemic stroke.”
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