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Withdrawing Patients from Statin Therapy During Acute Phase of Ischemic Stroke Leads to Worse Outcomes and Neurological Deterioration: Presented at ISC

By Cameron Johnston

KISSIMMEE, FL -- February 17, 2006 -- Patients who are taken off statin therapy during the acute phase of an ischemic stroke may experience a 9.9-fold increase in their risk of early neurological deterioration and a 3.5-fold increase in the risk of poor neurological outcome, according to findings presented here at the International Stroke Conference (ISC).

Animal studies have shown that statin use could offer some protection against the damage of an ischemic stroke, according to lead researcher Florentino Nombela, MD, Neurogist, University Hospital de la Princesa, Madrid, Spain. In humans, statins are believed to offer some degree of neuroprotection, although this has benefit has not been unexplained, he said during his presentation on February 16^th.

In their study, Dr. Nombela and colleagues evaluated 215 patients who were admitted to hospital within 24 hours of ischemic stroke onset and who were using statins. The researchers randomized 43 of these patients to continue taking their statins during the first 3 days in hospital and 46 to stop their statin therapy at this time. A third group of 126 patients who were not taken statins at stroke onset were included as controls.

Patients who continued using statins were switched to 20 mg/day of atorvastatin regardless of the dose of the drug they had previously been taking.

Patients were well-matched for baseline characteristics.

Study endpoints included early neurological deterioration, which was defined as a loss of 4 or more points on the National Institutes of Health Stroke Scale (NIHSS) within the first 48 hours of hospital admission, an increase in infarct volume at days 4 to 7, and poor functional outcome, defined as a modified Rankin score (mRS) of more than 2 points at the end of 3 months.

Results show early neurological deterioration occurred in 65.2% of patients who were withdrawn from statins at admission, and in 20.9% of those who remained continued their statin therapy. Of patients who were not on statins at admission, 27% experienced early neurological loss.

Poor outcomes on the mRS were seen in 58.7%, 37.2% and 42.1% of patients who stopped statin therapy, continued statin therapy, and were not on statins at admission, respectively.

Mean increase in infarct volume was 74 cc in the statin withdrawal group, 26 cc in the group that continued on statins and 53 cc in the control group.

Dr. Nombela said it is not clear why patients who were not taking statins during the first 3 days in hospital had two different levels of response -- the group that stopped taking statins and the larger control group who were not on statins at admission.

He suggested that statin withdrawal leads to a subsequent increase in inflammatory markers such as interkeulin-6 and VCAM-1, which may be associated with a significant increase in inflammatory responses, thereby leading to a worse outcome.

"The potential benefit of statin therapy prior to stroke onset has been described previously, and can be dramatically lost if the treatment is stopped during the acute phase -- even if only for a brief period," Dr. Nombela said.

"The statin withdrawal syndrome can play a negative role that must not be forgotten when managing patients in the acute phase of ischemic stroke," he added.


[Influence of Statin Withdrawal on Acute Ischemic Stroke Outcome: A Randomized Prospective Study. Abstract 27]

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