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Expanding indications for statins in cerebral ischemia: a quantitative study
Bruce Ovbiagele1, Chelsea S Kidwell, Jeffrey L Saver
1Stroke Center and Department of Neurology, UCLA Medical Center, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
Archives of Neurology
|January 12, 2005
Summary
Most stroke patients meet criteria for statin therapy, but current guidelines may limit access. Broader indications, like those from the Heart Protection Study, ensure more patients benefit from statins to prevent further cerebrovascular events.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- US FDA labeling in 2003 recognized stroke and cerebrovascular disease for initiating statin (simvastatin) therapy.
- This decision was based on Heart Protection Study results, expanding statin indications beyond existing US and European guidelines.
- The study aimed to evaluate the clinical practice impact of these broadened statin indications in stroke patients.
Purpose of the Study:
- To assess the impact of expanded statin indications on clinical practice for stroke patients.
- To determine the proportion of ischemic stroke patients meeting criteria for statin initiation under various guidelines.
Main Methods:
- An observational study was conducted at a university hospital stroke service.
- One hundred consecutive patients with ischemic stroke and transient ischemic attack were analyzed.
- Algorithms were developed using National Cholesterol Education Program Adult Treatment Panel III, European Joint Task Force II, Heart Protection Study criteria, and FDA labeling to assess statin initiation eligibility.
Main Results:
- The study included 100 patients (average age 74 years; 64% female, 74% white).
- Statin initiation criteria were met by 48% (NCEP III), 38% (European JTF II), 92% (Heart Protection Study), and 100% (FDA labeling).
- Twenty patients were already on statins upon admission.
Conclusions:
- The majority of ischemic stroke patients meet clinical trial-validated criteria for statin therapy initiation.
- Strict adherence to current national and international guidelines may prevent up to half of these patients from receiving beneficial statin treatment.
- Broadened indications, such as those based on the Heart Protection Study and FDA labeling, are crucial for optimizing statin use in stroke patients.