Stopping Statins After Stroke Doubles Death Risk
THURSDAY Aug. 30, 2007 -- Stroke survivors who stopped taking cholesterol-lowering statins doubled their risk of dying in the next year compared to those who stayed on the medications, an Italian study finds.
A number of other studies have shown the benefits of using statins after a stroke, the study authors noted.
For instance, the Italian study comes on the heels of a Spanish study that found discontinuation of statin therapy by stroke patients is associated with an increased risk of death or dependency after 90 days.
The Spanish study of 89 people who had been taking statins before suffering a stroke found that 27 of the 46 patients who had an interruption of statin therapy were dead or dependent after three months, compared to only 16 of 43 who did not stop taking statins.
The American Heart Association currently recommends statin therapy after a stroke, said Dr. Larry Goldstein, director of the stroke center at Duke University. That recommendation was made before completion of a U.S. study "that showed for the first time that starting patients with no known cardiac disease after a stroke produced a significant reduction in the rate of recurrent stroke and in fatal stroke," Goldstein said.
The Italian study, by physicians at the San Filippo Neri Hospital in Rome and published in the Aug. 31 issue of Stroke, was "very well done," Goldstein said. It followed 631 stroke survivors whose average age was 70 and who had no other major illness, including heart disease. All were discharged from the hospital with orders to take a drug regimen that included statins.
But by the end of the four-and-a-half-year study, 38.9 percent of the patients had stopped taking statins, most of them quickly. The average time to discontinuation was 48.6 days.
A statistical analysis showed that discontinuing statin therapy was an independent risk factor for death from all causes. Eighty percent of the deaths recorded in the study were from cardiovascular disease.
About a quarter of the patients who stopped taking statins cited mild side effects, the most common of which was indigestion. No specific reason for discontinuing the drug therapy was given by the other patients or their doctors.
Current practice at Duke is to prescribe statins in many cases after a stroke, Goldstein said. "A patient who has coronary heart disease or diabetes should be on a statin," he said. "If there is no known coronary heart disease, we prescribe a statin for someone whose LDL cholesterol is between 100 and 190."
The Italian study also showed an increased risk of death in stroke survivors who stopped taking an anti-clotting drug such as Plavix, Goldstein noted. Their risk of death was 80 percent higher than in patients who took the drug as prescribed.
"Discontinuing either statins or antiplatelet drugs was associated with an increase in all-cause mortality," Goldstein said.
"Effective clinical strategies are needed to bring out a significant increase in patients who maintain their drug therapies," study author Dr. Furio Colivicchi said in a statement.
Many stroke survivors are eager to stop taking the medications, said Dr. Matthew Fink, chief of the division of stroke and critical care neurology at Weill Cornell Medical College in New York City. They generally are older people who are vulnerable to arthritis, he said.
"They have a tendency to have aches and pains, and they blame them on the statin," he said. "It's not due to the drug, but it's hard to convince them."
The two new reports both show that "most people who have had ischemic strokes should be treated with statins as part of their overall treatment," Fink said. Most strokes are ischemic, caused by blockage of a brain artery by a clot.
"The Spanish study looked at the acute effects in the hospital," Fink said. "The Italian study looked at the effect on outpatients. Both studies show the importance of continuing on these medications. When you start them, stay on them," he said.
Complete information on stroke treatment and recovery is provided by the National Library of Medicine.
Posted: August 2007