Statin Drugs Cut Risk of Recurrent Stroke

August 9, 2006 - HealthDay News

A new study supports the use of cholesterol-lowering statin medications after stroke -- even for patients without a prior history of heart disease.

Patients without such histories who took a statin drug -- which include Lipitor, Pravachol and Zocor -- reduced their risk of a second stroke by 16 percent over the next five years, researchers found.

While previous studies have indicated a benefit of post-stroke statin therapy, doctors now "have very clear clinical trial results to help guide therapy," said co-researcher Dr. Larry B. Goldstein, director of the Center for Cerebrovascular Disease and the Stroke Center at Duke University in Durham, N.C. "These results will have a major effect on how people are treated after a stroke," he added.

His team reported its findings in the Aug. 10 issue of the New England Journal of Medicine. The study was funded by drug maker Pfizer, which makes Lipitor.

Another expert said the study should help guide treatment.

"The authors of this paper argue that statin therapy should be part of treatment after a stroke," said Dr. David Kent, assistant professor of medicine at Tufts-New England School of Medicine, who wrote an accompanying editorial. "Overall, I would agree with that assessment."

The study included 4,731 people treated at 405 centers across the world for stroke or transient ischemic attacks, ministrokes caused by temporary blockage of a brain artery. Two-thirds had ischemic strokes, caused by complete blockage of a brain artery, another 30 percent suffered transient ischemic attacks, and 2 percent had hemorrhagic strokes, caused by a leaking blood vessel.

Although almost all the people in the study were already taking aspirin or another drug to reduce blood clotting, adding Lipitor to their usual stroke therapy reduced the incidence of a second stroke by 16 percent over an average 4.9 years of follow-up, compared to the group that did not get the statin, the researchers reported.

There was no difference in the overall death rate between the two groups, however, with 216 deaths in the Lipitor group vs. 211 deaths among those not taking the drug.

The people in the study were chosen carefully, Goldstein noted. Previous trials had shown a benefit after stroke for people with a history of coronary disease caused by narrowing of the heart arteries. Such patients were excluded from the study.

"What this study shows is that in this particular group of patients, statin therapy is associated with a very significant reduction in the risk of a second stroke," Goldstein said.

There was a slight increase in second stroke risk among the small group with rarer hemorrhagic stroke. However, "there were very few patients who had hemorrhagic strokes at the outset, so it was very difficult to make any meaningful conclusions," Goldstein said. "We currently are doing other analyses trying to understand the hemorrhagic issue."

But, he said, the implications of the study are clear for people who suffer ischemic strokes -- the great majority of stroke patients. "It provides evidence for the first time that patients with that kind of stroke should be started on a statin in the hospital or soon afterward," Goldstein said.

And while only one statin was used in this trial, Kent said that, "my belief is that it is a class effect," meaning the results should apply to other statin medications.

He cautioned that the results might not apply to people who have an ischemic stroke caused by a clot traveling to the brain from the heart, which occurs in about 20 percent of cases. But "for someone who has an ischemic stroke, the default position is to start a statin, unless you see a clear cause not to," Kent said.