Stroke outcome improves when patients continue taking cholesterol-lowering drugs

A new study has illustrated the risks involved when statin treatment is discontinued after a stroke and shows an increased risk of death or dependency is present for up to 90 days.

The study authors say recent reports have suggested that statins, the popular cholesterol-lowering drugs, such as Lipitor, Zocor or Mevacor, may protect the brain during the early phases of an ischemic stroke.

Ischemic strokes are the most common type of stroke and they occur when the blood flow to an area of the brain is cut off, usually by a clot, and the brain tissue no longer receives oxygen and begins to die.

Clinical studies suggest that withdrawal of statins impair the blood vessel function and worsens brain injury, however, oral medications are often stopped during the first days of a stroke because the patient may not be able to swallow them.

This latest study by Dr. Jose Castillo from Universidad de Santiago de Compostela, Spain, and colleagues investigated 89 stroke patients who had been on statin therapy.

The patients were assigned to have their statin stopped for the first 3 days after admission or to receive Lipitor immediately (orally or by nasogastric tube), regardless of prior statin drug and dosage; on day 4, all of the patients were given Lipitor.

The study found that after 3 months, 27 of the 46 patients (60 percent) who had an interruption in statin therapy were dead or dependent, compared to only 16 of 43 patients (39 percent) of the patients who did not withdraw from statin treatment.

Even after age and severity of the stroke were taken into consideration statin withdrawal was still linked with a 4.66-fold increased risk of death or dependency.

The study also found that statin withdrawal was associated with a 7-fold increased risk of early neurologic deterioration, as well as an increase in the area of volume of brain injury.

The researchers also found that the risk of adverse outcomes was similar between patients in the statin withdrawal group and in another group of patients who were not on a statin at time of their stroke.

Early neurologic deterioration and stroke volume, however, were significantly worse in the statin withdrawal group than in patients not previously treated with statins.

The findings suggest that after an ischemic stroke the protective effects of previous statin therapy on the brain disappear if the drug is withdrawn, which also has detrimental effects when compared with stroke patients who were not protected by statin treatment.

The researchers say their findings strongly support that previous statin therapy should not be interrupted during the acute phase of an ischemic stroke.

The study is published in the current issue of Neurology.