Early outcome of acute ischemic stroke in hyperlipidemic patients under atorvastatin versus simvastatin

Studies designed to evaluate the efficacy of atorvastatin on stroke suggest that, in addition to cholesterol lowering, this drug may play a role in poststroke neuroprotection. The objective of this historical-prospective study was to analyze the efficacy of atorvastatin (40-80 mg) or simvastatin (at an optimal dose) during the first 2 weeks after stroke in hyperlipidemic patients treated with simvastatin before stroke onset.

Medical records of all adult (aged >18 years) patients diagnosed with acute stroke were reviewed. Subjects were categorized on the basis of poststroke treatment exposure: atorvastatin (40 or 80 mg) or simvastatin (at an optimal dose). Each patient was examined using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Blood lipid profile was determined. All tests were performed at baseline and at 4 weeks after stroke.

A total of 371 patients (249 male and 122 female) were included. Subjects who received simvastatin were significantly older than those who received either dose of atorvastatin. Baseline differences in functional scores were not detected across treatment groups. Two weeks after stroke, subjects exposed to simvastatin had significantly poorer NIHSS and mRS scores than did subjects exposed to either atorvastatin dose. Atorvastatin 80 mg was associated with significantly better outcome compared with either of the other treatment groups. These differences persisted even after controlling for age and baseline scores.

Early outcome measured by NIHSS and mRS was better in acute stroke patients treated with atorvastatin than in those treated with simvastatin. These differences may reflect a neuroprotective effect unique to atorvastatin.