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Statin Treatment in Patients With Stroke With Low-Density Lipoprotein Cholesterol Levels Below 70 mg/dL
Joon-Tae Kim1, Ji Sung Lee2, Beom Joon Kim3
1Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School Gwangju Korea.
Insights
Statin therapy significantly reduced early vascular events and death in stroke patients with low baseline cholesterol. This treatment did not increase hemorrhagic stroke risk or alter stroke recurrence rates.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Uncertainty exists regarding statin efficacy for preventing early vascular events in acute ischemic stroke patients with baseline low-density lipoprotein cholesterol (LDL-C) <70 mg/dL.
- This patient group often has low LDL-C levels without prior statin use.
Purpose of the Study:
- To investigate the effectiveness of in-hospital statin treatment in reducing early vascular events in first-ever acute ischemic stroke patients with low baseline LDL-C (<70 mg/dL).
Main Methods:
- Analysis of a prospective, multicenter, nationwide registry of consecutive patients with first-ever acute ischemic stroke.
- Inclusion criteria: baseline LDL-C <70 mg/dL and no prior statin use.
- Inverse probability of treatment weighting (IPTW) was used to control for baseline characteristic imbalances.
Main Results:
- 74.2% of 2850 analyzed patients received in-hospital statin treatment.
- The primary composite outcome (stroke, myocardial infarction, all-cause death within 3 months) was significantly reduced with statin therapy (weighted HR, 0.54; 95% CI, 0.42-0.69).
- Statin use did not significantly alter the rates of stroke recurrence or increase the risk of hemorrhagic stroke (weighted HR, 1.11; 95% CI, 0.10-12.28).
Conclusions:
- In-hospital statin treatment is associated with reduced 3-month composite outcomes and all-cause mortality in ischemic stroke patients with low baseline LDL-C.
- Statin therapy appears safe in this population, with no increased risk of hemorrhagic stroke.
- Further research may explore optimal statin strategies in specific stroke patient subgroups.
Abstract:
Background It is unclear whether statin treatment could reduce the risk of early vascular events when baseline low-density lipoprotein cholesterol (LDL-C) levels are already low, at <70 mg/dL, at the time of the index stroke. Methods and Results This study was an analysis of a prospective, multicenter, nationwide registry of consecutive patients with first-ever acute ischemic stroke with baseline low-density lipoprotein cholesterol levels <70 mg/dL and without statin pretreatment. An inverse probabilities of treatment weights method was applied to control for imbalances in baseline characteristics. The primary outcome was a composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause death within 3 months. A total of 2850 patients (age, 69.5±13.4 years; men, 63.5%) were analyzed for this study. In-hospital statin treatment was used for 74.2% of patients. The primary composite outcome within 3 months occurred in 21.5% of patients in the nonstatin group and 6.7% of patients in the statin group (P<0.001), but the rates of stroke (2.65% versus 2.33%), hemorrhagic stroke (0.16% versus 0.10%), and myocardial infarction (0.73% versus 0.19%) were not significantly different between the 2 groups. After inverse probability of treatment weighting analysis, the primary composite outcome was significantly reduced in patients with statin therapy (weighted hazard ratio [HR], 0.54 [95% CI, 0.42-0.69]). However, statin treatment did not increase the risk of hemorrhagic stroke (weighted HR, 1.11 [95% CI, 0.10-12.28]). Conclusions Approximately three-quarters of the patients with first-ever ischemic stroke with baseline low-density lipoprotein cholesterol levels <70 mg/dL received in-hospital statin treatment. Statin treatment, compared with no statin treatment, was significantly associated with a reduced risk of the 3-month primary composite outcomes and all-cause death but did not alter the rate of stroke recurrence.
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