Statin Helps Keep Second Strokes at Bay

Lipitor study supports use of cholesterol-lowering drugs after attacks

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By
HealthDay Reporter

FRIDAY, May 4, 2007 (HealthDay News) -- Lowering blood cholesterol levels with a statin after a stroke or a mini-stroke cuts the risk of a second stroke or heart attack, French researchers report.

The finding held true even in patients with no previous history of heart disease, the team said.

This and other studies "have demonstrated a very clear treatment effect of statins, given before a stroke or after a stroke," said Dr. Majaz Moonis, director of stroke services at the University of Massachusetts, who has done extensive work in the field.

He was not involved in this study, which was presented at this week's annual meeting of the American Academy of Neurology, in Boston. The drug used in the study was atorvastatin, sold as Lipitor by Pfizer Inc., which financed the trial.

The new report, led by Dr. Pierre Amarenco, a neurologist at Denis Diderot University in Paris, involved more than 4,700 people who were first assessed within one to six months of a stroke or mini-stroke (TIA).

Half the participants got a statin drug, which includes medications such as Lipitor, Pravachol and Zocor. The other half did not receive the cholesterol-lowering drugs. The team then tracked the patients' outcomes for nearly five years.

Statins did seem to cut the risk of another stroke or heart attack. For example, a statin-induced 10 percent drop in blood levels of LDL "bad" cholesterol over 30 days was associated with a 4 percent reduction in the risk of a second stroke, and a 7 percent overall reduction in risk of a heart attack in people with no history of heart disease, the researchers said.

Other major research has turned up similar findings, but the report did add some ancillary information, said co-researcher Dr. Larry B. Goldstein, director of Duke University's stroke center in Durham, N.C.

A boost in levels of HDL cholesterol -- the "good" kind that helps keep arteries clear -- appeared to be important to better outcomes, as well, Goldstein noted. Another new finding was that lowering LDL cholesterol levels in the month after a stroke had a clear benefit.

Amarenco agreed. "It's encouraging to see that reducing cholesterol so quickly can have positive long-term effects," he said a statement.

And it was helpful to note that statins helped all patients, regardless of whether or not they had been diagnosed with heart disease before their stroke or TIA, Moonis said. That's something that hadn't been entirely clear before this study, he said.

The French findings strengthen the recommendation that "most patients who have acute ischemic stroke should receive statins, which should not only prevent a second stroke but also improve the outcome of the stroke," Moonis said.

For example, study participants were 60 percent more likely to be discharged to their homes rather than nursing homes if they had been taking statins before a stroke, and almost three times more likely to return home if they were taking a statin on discharge, he said.

An ischemic stroke, the most common kind, occurs when a blood clot blocks a blood vessel in the brain. Two-thirds of the people in the study suffered ischemic strokes, 30 percent had TIAs, and 2 percent had hemorrhagic strokes, in which a blood vessel bursts.

The drugs will not necessarily bring down LDL cholesterol levels at once, Moonis said. But they have other beneficial effects.

"They reduce inflammation, improve blood flow and also have an anti-thrombotic [anti-clotting] effect," Moonis said. "They are very good for the endothelium," the delicate inner lining of blood vessels, he added.

The value of statins for stroke patients has long been endorsed by the Stroke Council, a unit of the American Heart Association, which has issued a statement saying that "the vast majority of patients with a history of ischemic stroke or TIA could benefit from statin use."

More information

There's more on the study and its implications for stroke treatment at the American Heart Association.

SOURCES: Larry B. Goldstein, M.D., director, Duke University Stroke Center, Durham, N.C.; Majaz Moonis, M.D., director, stroke services, University of Massachusetts, Worcester; May 2, 2007, statement, American Academy of Neurology, Boston

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