High-dose statins after minor stroke tied to hemorrhage risk in a Chinese cohort
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Key takeaways:
- High-intensity statin therapy may increase bleeding risk after minor stroke.
- Statin dose, moderate or high, did not appear to have an effect on stroke recurrence.
Initiation of high-intensity statin therapy during the acute phase of minor, noncardiogenic stroke may increase bleeding risk, according to the results of a Chinese cohort study published in the Journal of the American Heart Association.
“The 2021 American Heart Association/American Stroke Association guidelines recommend high-intensity statin therapy for individuals at high risk for atherosclerotic cardiovascular disease. However, some randomized controlled trials have demonstrated that among Asian populations, more aggressive statin-based low-density lipoprotein cholesterol (LDL-C)-lowering treatments did not improve clinical outcomes or reduce the risk of stroke recurrence,” Hai-mei Fan, MD, PhD, from the department of neurology at First Hospital of Shanxi Medical University in Taiyuan, China, and colleagues wrote. “Therefore, it is unknown whether Asian populations benefit more from intensive statin therapy for secondary stroke prevention.”
For the secondary report from the SEACOAST study, Fan and colleagues analyzed outcomes data from 2,950 patients with mild ischemic stroke who presented within 72 hours of symptom onset to eight hospitals in Shanxi province, China.
Moderate or intensive statin dose was defined in accordance with the 2018 AHA/American College of Cardiology cholesterol guideline.
Daily rosuvastatin 20 mg or atorvastatin 40 mg to 80 mg were considered high-intensity statin treatments. Daily atorvastatin 10 mg to 20 mg, rosuvastatin 5 mg to 10 mg, simvastatin 20 mg to 40 mg, pitavastatin 2 mg to 4 mg or pravastatin 40 mg to 80 mg were considered moderate-intensity statin treatments.
The primary efficacy outcome was stroke recurrence and the primary safety endpoint was intracranial hemorrhage.
After adjusting for potential confounders in a matched Cox multivariate analysis, the researchers found that risk for stroke recurrence at 3 and 12 months was similar in the high- and moderate- intensity statin groups (adjusted HR at 3 months = 1.12; 95% CI, 0.85-1.49; P = .424; aHR at 12 months = 1.08; 95% CI, 0.86-1.34; P = .519). However, high-intensity statin therapy was associated with increased risk for intracranial hemorrhage compared with moderate-intensity statin therapy at both time points (aHR at 3 months = 1.81; 95% CI, 1-3.25; P = .048; aHR at 12 months = 1.86; 95% CI, 1.1-3.16; P = .021). It was also associated with elevated risk for any bleeding events (aHR = 1.44; 95% CI, 1.08-1.93; P = .013).
The researchers also utilized propensity-score matching to control for imbalances in baseline factors, which produced results consistent with the Cox multivariate analysis.
“This cohort study suggests that compared with moderate-intensity statin therapy, high-intensity statin medication in the acute period may not positively influence clinical outcome of patients with minor, noncardiogenic ischemic stroke,” the researchers wrote. “In practice, maybe a moderate dosage of statins is appropriate for the secondary prevention of mild stroke.”
Due to the study being mainly completed during the COVID-19 pandemic, the researchers noted a lack of follow-up data for variables such as lipids, liver function, muscle enzymes and kidney function. Lack of these data prevented the researchers from completing a more comprehensive analysis of the adverse reaction rate of different statin doses after minor stroke.
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