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Statins Help Some Stroke Patients

Cholesterol-lowering drugs seem to reduce risk of complications, studies find

THURSDAY, July 28, 2005 (HealthDay News) -- Cholesterol-lowering statin drugs reduce the incidence of a potentially deadly complication in patients who have strokes caused by a burst blood vessel, British and American researchers report.

Two studies reported in the August issue of the journal Stroke focused on a relatively small number of people who suffered subarachnoid hemorrhages, in which a blood vessel rupture causes bleeding into the space between the brain and the skull. Many of those patients later have vasospasm, a prolonged contraction of blood vessels that can lead to another stroke.

In the British study, neurologists at the University of Cambridge gave pravastatin (Pravachol) to half of a group of 80 patients for 14 days, starting within 72 hours of a stroke. Patients who got the statin were 32 percent less likely to develop vasospasm than those who got a placebo, the researchers found.

Both the incidence of vasospasm-caused disability and death was substantially lower in the patients getting the statin. Their in-hospital death rate was 75 percent lower and the incidence of vasospasm-caused disability, such as partial paralysis, was 83 percent lower than for patients who did not get the drug.

In the American study, a group led by Dr. John R. Lynch of Duke University Medical Center gave either a different drug, simvastatin (Zocor), or a placebo to 39 people, starting within 48 hours of a stroke. Only a quarter of the patients who got the drug had evidence of vasospasm during the 14-day trial, compared to 60 percent of those who didn't get the drug.

Because the studies were small, they must be verified by a larger trial, said Lynch, who is assistant professor of neurology and medicine at Duke. Such a trial is now in the planning stage, he said.

"We are looking at four centers in the United States and maybe one in Europe," Lynch said. "We are looking for National Institutes of Health financing. We plan to submit an application in October."

Another possibility is financing by a pharmaceutical company, he said.

One factor to be explored in the trial would be to determine the best dose of statin therapy, Lynch said. Mouse studies have indicated that a higher dose than the one used in his trial, 80 milligrams, might be more effective, he said.

"Much higher doses, up to 10 times higher, might be better," Lynch said. "But that might cause adverse side effects, such as muscle breakdown and liver damage."

Lynch said he has already incorporated statin therapy into the treatment of patients with the kind of stroke dealt with in the study. He is using the same dosage -- 80 milligrams a day for 14 days.

And the research "may have wider implications for other forms of stroke," Lynch said.

That's still an open question, said Dr. Larry Goldstein, professor of medicine at Duke and vice chairman of the American Heart Association's Stroke Council.

Studies have shown that giving statins to people with coronary heart disease can reduce their risk of stroke by 20 percent, Goldstein said. "And there is also some evidence that you can reduce the risk of major vascular events [such as heart attack] in patients who have had strokes by prescribing statins," he said.

But there is no conclusive evidence of benefit from giving statins after an ischemic stroke, which is caused by blockage of a brain artery, Goldstein said. That issue is now being studied in a major trial, with results expected "in a year or so," he said.

Another report in the same issue of the journal concerned drugs that stroke patients should be getting, but too often don't: medications for high blood pressure.

Data on 764 patients in the California Acute Stroke Prototype Registry showed that only 69.4 percent of them were given blood pressure medications when they left the hospital. High blood pressure is a major risk factor for stroke, said lead study researcher Dr. Bruce Ovbiagele, assistant professor of neurology at the University of California, Los Angeles.

One reason why those medications were not given more often is that guidelines for stroke do not specify that blood pressure therapy should be started in the hospital, Ovbiagele said in a statement.

"There should be a concerted effort involving patients and their doctors to make sure that patients do not leave the hospital without being on at least one blood pressure agent to reduce their risk for secondary stroke," he wrote.

More information

For more on stroke, visit the National Institute of Neurological Disorders and Stroke.

SOURCES: John R. Lynch, M.D., assistant professor of neurology and medicine, and Larry Goldstein, M.D., professor of medicine, both with Duke University Medical Center, Durham, N.C.; August 2005, Stroke
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