Statin therapy associated with reduction in recurrent stroke, improved survival at 10 years

Patients who had their first stroke and were prescribed statin therapy after hospital discharge had a reduction in recurrent stroke and improved survival at 10 years, according to new data in this week's Neurology.

Researchers enrolled 794 consecutive patients with their first stroke in the retrospective study, of which 198 were assigned statin therapy upon discharge. The researchers evaluated available data at one month, six months and 12 months following first event and yearly thereafter. The primary endpoint of the study was recurrent stroke and death.

The researchers reported that 112 (14.1%) patients had a recurrent event. The recurrence rate was higher among patients who were not assigned a statin at hospital discharge vs. those who were assigned a statin (16.3% vs. 7.5%). Following Cox regression analyses, the researchers reported that only statin therapy postdischarge was an independent predictor of stroke (HR=0.61; 95% CI, 0.35-0.92). Statin therapy was also a strong predictor of the long-term recurrence of stroke after adjusting for efficacy of blood pressure control and lipid level control achieved that was 12 months following the first incidence of stroke (HR=0.65; 95% CI, 0.39-0.97). There were 224 deaths reported during follow-up, and Kaplan-Meier survival curves suggested that patients who were prescribed a statin at discharge had a lower rate of recurrent stroke (P=.026) and improved survival (P<.001) vs. those off-statin.

“Our findings support the need for statin treatment in the secondary prevention of stroke and the need for more studies in the future, including lipid-lowering treatment modalities standardized to a particular drug or to a particular dosage regimen,” the researchers concluded. “These studies should also examine whether the benefit of statins reducing the risk of first-time or recurrent stroke is due to their potent lipid-lowering effects, pleiotropic effects or a combination of the two.” – by Eric Raible

Milionis H. Neurology. 2009;72:1816-1822.

This is observational data, not a randomized study, thus it is best described as "hypothesis-generating." The most that can be said is that there is an association, and the study title is actually misleading, as cause and effect cannot be assumed. There may be (and often are in observational data) other characteristics related to both stroke incidence and statin use that explain the association.

– Rita Redberg, MD

Director of Women's Cardiovascular Services Department of Medicine,
University of California San Francisco Medical Center