Stay the Statin Course During Acute Stroke Care : Separate studies suggest that discontinuing statins increases neurologic deterioration and mortality.


KISSIMMEE, FLA. — Stroke patients who take statins should continue to do so during their acute stroke treatment, because withdrawing the drugs for as brief a time as 3 days is associated with significant worsening of neurologic outcomes, researchers said at the 31st International Stroke Conference.

“Statins have not been considered essential drugs that must be continued when a patient is hospitalized for stroke,” Dr. Florentio Nombela commented in an interview.

“When stroke patients can't swallow, or when we are trying to simplify their medication routines during this time, we often discontinue the statins just to make things easier. Our study shows that this should not be done.”

Dr. Nombela of the Hospital Universitario de la Princesa, Madrid, examined statin withdrawal in 89 ischemic stroke patients. During the first 3 days after admission, statins were withdrawn from 46 patients and continued in 43 patients. All patients began atorvastatin 20 mg/day on day 4 of admission.

Patients from whom statin therapy was withdrawn were nine times more likely than patients who continued on statins to experience early neurologic deterioration (a decrease of at least 4 points on their National Institutes of Health Stroke Scale score).

Early deterioration occurred in 65% of the withdrawal group (30 patients) and 21% of those in the continued therapy group (9 patients).

Upon imaging during days 4–7, patients in the withdrawal group had larger brain infarcts than those in the continued therapy group (74 cm

The withdrawal patients were 3.5 times more likely to have poor functional outcome (modified Rankin Scale score of 2 or higher) at 3 months. In the withdrawal group, 59% had poor functional outcome, compared with 37% of those in the continued therapy group.

Norinna Allen, who is a doctoral student at Yale University, New Haven, Conn., noted that use of lipid-lowering agents may provide some mortality protection when they are administered during the acute phase of stroke treatment, although there is a lack of prospective data to confirm this finding.

Her retrospective chart review included 1,256 patients admitted for ischemic stroke at 32 academic medical centers. Of the group, 41% received a statin during their stroke hospitalization and the rest did not, noted Ms. Allen, who was discussing her findings in an interview at the meeting sponsored by the American Stroke Association.

The chart review indicated only the dispensing of a statin, Ms. Allen pointed out; it did not differentiate between an existing prescription and a new prescription.

Patients who were on statins had a significantly lower rate of in-hospital mortality (1% vs. 5%). In a multivariate analysis, statin use was associated with an 80% decrease in mortality.

There was a trend toward better long-term functional outcomes, Ms. Allen said. Among those who received a statin, 58% were discharged to home (indicative of a good outcome), compared with 53% of those who didn't get a statin.

“This suggests an important relationship may be occurring, but what is exactly happening is very unclear right now,” she said.

“Recent studies do suggest that statins confer a mortality benefit in heart disease patients, beyond their ability to lower lipids,” she noted.

Dr. Nombela noted that research findings have suggested that statins have a profound effect on endothelial function. When the drugs are withdrawn, the levels of nitric oxide drop to below baseline, which causes endothelial dysfunction. The drugs also exert an anti-inflammatory effect that disappears when they are withdrawn.

Patients in the statin withdrawal group had larger brain infarcts than did those in the continued therapy group. DR. NOMBELA

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