Catch 22 for Stroke Patients

Statin risks may outweigh cardiovascular benefits for stroke patients

(RxWiki News) Statin drugs such as Crestor and Lipitor, which work to lower LDL, or "bad" cholesterol and guard against heart disease and stroke, may actually pose more threat than benefit to stroke patients.

For patients with a history of bleeding in the brain, a computer-decision model suggests that a recurrence associated with statin use may outweigh the benefits of preventing cardiovascular disease. The advisability of statin use in those at high risk of intracerebral hemmorhage is unclear, according to findings from Massachusetts General Hospital and Harvard Medical School.

In a clinical trial of secondary stroke prevention, an increased incidence of intracerebral hemorrhage was seen among subjects randomized to statin therapy.

Secondary stroke prevention is the series of treatments and interventions implemented with a patient after he or she has the first stroke, such as control of hypertension, cholesterol control, weight loss, and control of diabetes among others.

M. Brandon Westover, M.D., Ph.D., of Massachusetts General Hospital and Harvard Medical School, and colleagues write that it is important to weigh these risks in light of the fact that intracerebral hemorrhage sufferers commonly have co-occurring cardiovascular risk factors that generally warrant statin drugs.

The authors note that the mechanism by which statins increase stroke risk are unknown, but suggest it could be due to the anti-clotting properties of the drugs, which may cause increased risk of bleeding in the brain.

Meanwhile, another study conducted in Tel Aviv has found that consistent use of statins in the general population (meaning no other serious health problems) is associated with lower risk of death.

A study from Maccabi Healthcare Services and Sackler Faculty of Medicine in Tel Aviv looked at data from 229,918 adults (average age 57) enrolled in a health-maintenance plan who took statins between 1998 and 2006. Of these, 136,052 individuals were part of a primary-prevention group (without heart disease), followed for an average of four years, and 93,866 comprised a secondary-prevention group who were already diagnosed with heart disease, followed for five years on average.

The scientists researched statin use by calculating the proportion of days each person took the drugs. A total of 4,259 patients in the primary-prevention group (136,052) and 8,906 in the secondary-prevention group (93,866) died during the study. In both groups, those who took statins for at least 90 percent of the follow-up period matched with a 45 percent reduction in risk of death compared with those who took the drugs less than 10 percent of the time.

Review Date: 
January 11, 2011