Physicians' Academy for Cardiovascular Education

Higher risk of recurrent stroke after early statin discontinuation

Utilization of Statins Beyond the Initial Period After Stroke and 1-Year Risk of Recurrent Stroke

Lee M, Saver JL, Wu Y-L, et al. - J Am Heart Assoc. 2017;6:e005658

Background

Guidelines recommend statin therapy for patients with a history of ischemic stroke or TIA, but in every-day clinical practice, many high-risk patients are not maintained on statin therapy beyond the first 3 months [1-5]. The effects of discontinuing or reducing statin treatment early after an index ischemic stroke have not been adequately studied.

This study evaluated the effects of statin discontinuation or statin dose reduction on the risk of recurrent stroke in a large, retrospective cohort study, by retrieving all hospitalized patients (≥20 years) with a primary diagnosis of ischemic stroke from January 1, 2001 to December 31, 2012 in the Taiwan National Health Insurance Research Database.

The study population was followed from day 181 after the index stroke for 1 year. Patients with AF, patients not receiving antiplatelet therapy, patients with end-stage renal disease, and patients with a recurrent stroke within 180 days of the index stroke were excluded from the study. The intensity of the statin therapy was defined based on the 2013 ACC/AHA guidelines on the treatment of blood cholesterol [3].

Patients were categorized into 3 groups:

Main results

Compared with the statin-maintained group, the discontinuation of statins was associated with higher risks of:

Conclusion

The discontinuation of statin therapy 3 to 6 months after an index ischemic stroke event, was associated with a higher risk of recurrent stroke within 1 year after statin discontinuation. These findings suggest that stroke patients should not discontinue statin therapy, unless there is a serious reason for doing so.

References

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