Statin withdrawal after stroke worsens outcome

NEW YORK (Reuters Health) - Discontinuing statin treatment after a stroke is associated with an increased risk of death or dependency after 90 days, according to a study in the medical journal Neurology.

Recent reports suggest that statins, a popular class of cholesterol-lowing drugs, such as Zocor or Mevacor, may protect the brain during the early phases of an ischemic stroke, the authors explain. An ischemic stroke, the most common type of stroke, occurs 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.

The results of 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.

Dr. Jose Castillo from Universidad de Santiago de Compostela, Spain, and associates 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 put on Lipitor.

After 3 months, 27 of the 46 patients (60 percent) who had an interruption in statin therapy were dead or dependent, the authors report, compared with 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 considered, statin withdrawal was still associated with a 4.66-fold increased risk of death or dependency.

In other findings, 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 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, the investigators found. 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that after an ischemic stroke the protective effects of previous statin therapy on the brain disappear if the drug is withdrawn, which also cause deleterious effects when compared with stroke patients who were not protected by statin treatment, the authors conclude.

"Our findings strongly support that previous statin therapy should not be interrupted during the acute phase of ischemic stroke."

SOURCE: Neurology 28, 2007.