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Effect of Statin Therapy on Cardiovascular Outcome in Stroke Patients with Low Baseline Low-Density Lipoprotein
Yong Soo Kim1,2, Han-Gil Jeong3, Jun Young Chang4
1Department of Neurology, Nowon Eulji Medical Center, Seoul, Korea.
Insights
Post-stroke statin therapy significantly reduced major vascular events in patients with low LDL-C levels. This finding supports statin use even when cholesterol is below target after a stroke.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Ischemic stroke patients often have low-density lipoprotein cholesterol (LDL-C) below recommended targets.
- The efficacy of statin therapy in such patients post-stroke is not well-established.
Purpose of the Study:
- To determine if post-stroke statin therapy reduces major vascular events in statin-naïve patients with LDL-C below target levels.
- To analyze the impact of statin intensity on outcomes.
Main Methods:
- Retrospective analysis of ischemic stroke patients (2011-2020) with baseline LDL-C below target.
- Weighted Cox regression using stabilized inverse probability treatment weighting to assess major vascular events (stroke, myocardial infarction, death).
Main Results:
- Post-stroke statin therapy was associated with a 45% lower risk of major vascular events within 1 year (weighted HR 0.55).
- This benefit was observed even in subgroups with LDL-C <55 mg/dL or <70 mg/dL.
- Statin intensity influenced outcomes differently based on stroke subtype.
Conclusions:
- Statin therapy can improve vascular outcomes after ischemic stroke, even in patients with pre-treatment LDL-C below target.
- These findings suggest a potential role for statins in secondary stroke prevention beyond current guidelines.
Objectives:
To investigate whether post-stroke statin therapy reduces subsequent major vascular events in statin-naïve patients with pretreatment low-density lipoprotein cholesterol (LDL-C) below the recommended target (≤70 mg/dL for atherosclerotic stroke and ≤100 mg/dL for non-atherosclerotic stroke) at stroke onset.
Methods:
Patients from an ongoing stroke registry who had an ischemic stroke between 2011 and 2020 were screened. Statin naïve patients with baseline LDL-C below the target were assessed. The effect of post-stroke statin therapy on major vascular events (composite of recurrent stroke, myocardial infarction, and death) was investigated using weighted Cox regression analyses using stabilized inverse probability treatment weighting.
Results:
The baseline LDL-C level of the 1,858 patients (mean age 67.9 ± 15.3 years, 61.4% men, 13.2% atherosclerotic stroke) included in the study was 75.7 ± 17.0 mg/dL. Statins were prescribed to 1,256 (67.7%) patients (low-to-moderate intensity, 23.5%; high intensity, 44.1%). Post-stroke statin therapy was associated with a lower risk of major vascular events during 1-year follow-up (weighted hazard ratio 0.55, 95% confidence interval 0.42-0.71). In a subgroup of patients who were at very high risk of atherosclerotic cardiovascular disease with LDL-C <55 mg/dL or patients who were not at very high risk of atherosclerotic cardiovascular disease with LDL-C <70 mg/dL, post-stroke statin therapy was also associated with a reduction in major vascular events (weighted hazard ratio 0.45, 95% confidence interval 0.29-0.70). The intensity of the most beneficial statin varied by subtype of stroke.
Interpretation:
Statin therapy may improve vascular outcomes after ischemic stroke, even in cases of LDL-C below the target without pre-stroke lipid-lowering therapy. ANN NEUROL 2024;95:876-885.
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