Quitting statins raises risk of a second stroke 

Patients who stop taking statins after suffering a stroke are at greater risk of suffering another one within a year, according to new research. 

Researchers also found that discontinuing statins, which lower cholesterol, between three and six months after a first ischemic stroke was linked to higher risk of death and hospitalization among the patients in the study.

But another new study reveals less than half of American stroke victims receive a prescription for the cholesterol-lowering drugs.  

The papers, published today by the American Heart Association, lay bare a worrying trend that could be hampering efforts to curb strokes, the fifth-biggest killer in the US.

Statins are given to patients to lower cholesterol to avoid heart and brain attacks 

The researchers concede that some people stop taking statins voluntarily, since they cannot stand the side effects of nausea and drowsiness long term. 

But they advise those patients should switch to a lower-intensity drug to protect themselves from narrowing arteries. 

More concerning, they say, is the issue of doctors failing to prescribe statins after an ischemic stroke, the type caused by narrowed arteries.

Ischemic strokes – the most common type of stroke – may be caused by a build-up of cholesterol in the arteries, which blocks blood flow to brain.

If levels of LDL (low-density lipoprotein) ‘bad’ cholesterol is too high, statins can reduce the risk of a recurrent stroke because they lower the artery clogging.

THE RISK OF STOPPING STATINS

Researchers at the Chang Gung University College of Medicine in Taiwan studied people who had been hospitalized by a stroke.

All the participants received either high or moderate intensity statins within three months after they left the hospital.

Compared to people who continued taking statins throughout the one-year follow-up period, the risk of having another stroke increased 42 percent for patients who stopped taking statins.

But there was no additional risk of having another stroke or death for patients who continued taking statins at a decreased dose.

However, the risk of death from any cause increased 37 percent after discontinuing statins, according to the results published in the Journal of the American Heart Association.

Study lead author Doctor Meng Lee said: ‘Based on our findings of this large group of patients in the real world,’ we believe that statins should be a lifelong therapy for ischemic stroke patients if a statin is needed to lower the patient’s cholesterol.’

Researchers used medical data collected by the Taiwan National Health Insurance Program.

The study included 45,151 ischemic stroke patients between 2001 and 2012 who were prescribed a statin within 90 days after leaving the hospital.

The study period included the three to six months following discharge, during which time 3,175 patients (seven percent) were on reduced statin therapy and 8,353 (18.5 percent) were not on any statin therapy.

The study was retrospective, meaning the researchers only used data from the patients’ medical histories, so they cannot determine why some stroke patients stopped taking statins.

WHAT IS A STROKE? 

There are two kinds of stroke:

1. ISCHEMIC STROKE

An ischemic stroke – which accounts for 80 percent of strokes – occurs when there is a blockage in a blood vessel that prevents blood from reaching part of the brain.

2. HEMORRHAGIC STROKE

The more rare, a hemorrhagic stroke, occurs when a blood vessel bursts, flooding part of the brain with too much blood while depriving other areas of adequate blood supply.

It can be the result of an AVM, or arteriovenous malformation (an abnormal cluster of blood vessels), in the brain.

Thirty percent of subarachnoid hemorrhage sufferers die before reaching hospital. A further 25 percent die within 24 hours. And 40 percent of survivors die within a week.

RISK FACTORS

Age, high blood pressure, smoking, obesity, sedentary lifestyle, diabetes, atrial fibrillation, family history, and history of a previous stroke or TIA are all risk factors for having a stroke.

SYMPTOMS OF A STROKE

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body 
  • Sudden confusion, trouble speaking or understanding 
  • Sudden trouble seeing or blurred vision in one or both eyes 
  • Sudden trouble walking, dizziness, loss of balance or coordination 
  • Sudden severe headache with no known cause 

OUTCOMES 

Of the roughly three out of four people who survive a stroke, many will have life-long disabilities.

This includes difficulty walking, communicating, eating, and completing everyday tasks or chores.

TREATMENT

Both are potentially fatal, and patients require surgery or a drug called tPA (tissue plasminogen activator) within three hours to save them. 

But Dr Lee said recommendations by the Taiwan National Health Bureau to stop or reduce statins in stroke patients once the level of LDL-cholesterol is less than 100 mg/dl or total cholesterol of less than 160 mg/dl were achieved may have led to the discontinuation of statins for some of the patients in the study.

Although the study was comprised entirely of patients from Taiwan, Dr Lee said the results should be applicable to patients elsewhere.

He added: ‘Discontinuation of statin treatment in patients with ischemic stroke should be strongly discouraged in any stage, acute or chronic, of stroke.

‘Shifting to low-intensity statin therapy could be an alternative for stroke patients not able to tolerate moderate or high intensity statin therapy in the years following a stroke.’

TREND OF FAILING TO PRESCRIBE STATINS

Researchers at the Birmingham VA Medical Center in Alabama found less than half of stroke patients discharged from the hospital received a prescription for cholesterol-lowering medications statins.

The researchers looked at demographic and health information, including stroke risk factors, for 323 stroke patients participating in a national study of more than 30,000 U.S. adults age 45 and older from 2003 to 2013. 

The study used computer-assisted telephone interviews, questionnaires, an in-home examination, and medical records from the stroke hospitalization and discharge. 

They warned the likelihood of a prescription varied by patients’ geographic location, sex, age and race. 

The American Heart Association recommends statin therapy to reduce the risk of recurrent stroke and other cardiovascular events after an ischemic stroke.

Statins are the only cholesterol-lowering drug class that have been shown to reduce the risk of recurrent stroke.

Compared to other areas, death from stroke is more common in the so-called Stroke Belt of the South – in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.

Previous studies have shown, however, that statin prescriptions are lower among stroke patients discharged in the south and among blacks, women and older patients.

To evaluate the magnitude of these differences by age, sex, and race inside and outside of the Stroke Belt, researchers in a new study compared statin use between different groups of patients with ischemic stroke, both in and outside the Stroke Belt.

The study found that 49 percent of stroke patients, overall, received a prescription for statins at hospital discharge, and the percentage of patients receiving prescriptions increased over the course of the 10-year study. 

Unlike previous research, the study did not find that black patients were less likely than whites to receive statins. 

In fact, the study found, outside of the Stroke Belt black patients were more likely than white patients to receive statins.  

‘All survivors of ischemic stroke should be evaluated to determine whether they could benefit from a statin, regardless of the patient’s age, race, sex or geographic residence,’ said study lead author Karen Albright.

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