High mortality in stroke patients who stop statins

By Will Boggs, MD

NEW YORK (Reuters Health) - Patients who stop statin therapy after they have a stroke have high mortality rates over the next 12 months, according to a report in the current issue of the medical journal Stroke.

"Our study is the first one to show that in ischemic stroke survivors, statin therapy discontinuation doubles the risk of premature death," Dr. Furio Colivicchi from San Filippo Neri Hospital, Rome, told Reuters Health.

An "ischemic" stroke, the most common type, is caused by a clot that blocks a blood vessel in the brain, resulting in ischemia - when the tissue is deprived of oxygen. The clot very frequently is a plaque that breaks loose from an artery wall of a person with arthrosclerosis.

"This result is in accordance with all previous investigations showing that patients with atherosclerotic vascular disease should never discontinue statin therapy," Colivicchi added.

His research team assessed the impact of discontinued statin therapy on the outcome of patients discharged after a stroke. "Statins" are a class of frequently prescribed drugs that lower cholesterol and include atorvastatin, sold under the trade name Lipitor; simvastatin, sold as Zocor; and rosuvastatin, sold as Crestor.

In the study, there were 116 deaths among 631 stroke survivors. Cessation of statin therapy was associated with a nearly three-fold increased risk of mortality from any cause over 1 month, the authors report. Earlier discontinuation of statin therapy was also associated with a higher risk of mortality.

Patients who discontinued statin therapy were significantly older and more frequently female, compared with those who continued on statin therapy. Patients who continued therapy were also more likely to have diabetes or have had a previous stroke.

After further, the researchers found that older age and stroke severity at hospital admission were also independent predictors of increased mortality, as was discontinuation of antiplatelet (anticoagulant) therapy.

"All patients with ischemic stroke should be on statin therapy and should not stop unless there is a significant and compelling reason," Colivicchi said. "Besides, all patients with cerebrovascular disease should be on antiplatelet therapy and achieve effective blood pressure control, while also trying to follow all dietary and exercise recommendations."

"Patients with major cardiovascular conditions should be more closely followed for adherence to prescribed treatments," Colivicchi added. "Specific and individual treatment plans should be developed for every single patient in the primary care setting."

SOURCE: Stroke, October 2007.