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Interrupting Statins Worsens Acute Stroke Outcomes

Withholding statins after acute stroke substantially increased the likelihood of death or disability.

Oral administration of ongoing medications, including statins, is often interrupted in stroke patients who are unable to swallow, to reduce their risk of bronchoaspiration. Emerging data indicate, however, that statin treatment may be beneficial in the acute phase of stroke and that precipitous withdrawal of statin therapy might be associated with untoward clinical effects. To properly assess the clinical consequences of statin interruption in acute stroke, these authors randomized 89 patients who had experienced acute ischemic stroke and who were taking statins, to either continue the medication regimen or interrupt it for the first 3 days after admission.. The 43 patients whose statin treatment was uninterrupted received 20 mg of atorvastatin daily (orally or by nasogastric tube). Investigators who were blinded to treatment assignments evaluated patients’ 3-month poststroke outcomes

Statin interruption was associated with significantly higher rates of death and dependency (modified Rankin Scale score >2) at 3 months than was continuation (60% vs. 39%). Furthermore, a statistical model adjusted for age and stroke severity indicated that interruption was associated with a greater than fourfold increase in the odds of death and dependency.

Comment: These results are consistent with those of previously reported retrospective studies in hospitalized patients with acute coronary syndrome and acute stroke, which showed that clinical outcomes were poorer, and cerebral infarct volumes were larger, in patients whose statin therapy was discontinued. Given the randomized and blinded design of the current study, these data provide the most compelling argument to date against interrupting statin treatment during hospitalization for acute stroke.

— Nerses Sanossian, MD, and Bruce Ovbiagele, MD

Dr. Sanossian is Assistant Professor of Neurology, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Ovbiagele is Associate Professor, Department of Neurology, UCLA, and Director, Olive View–UCLA Stroke Program.

Published in Journal Watch Neurology December 11, 2007

Citation(s):

Blanco M et al. Statin treatment withdrawal in ischemic stroke: A controlled randomized study. Neurology 2007 Aug 28; 69:904.

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