Statin therapy reduces major vascular events after stroke

Treatment with statin results in a decrease in major vascular events following acute ischaemic stroke, even in patients with low or well-controlled low-density lipoprotein cholesterol (LDL-C), as shown in a study presented at ISC 2023.

However, achieved LDL-C levels do not appear to have any impact on poststroke major vascular events in this population.

“Poststroke statin therapy is known to reduce subsequent major vascular events in patients with ischaemic stroke,” according to researchers Yong Soo Kim and colleagues. “However, the efficacy of statin therapy in acute ischaemic stroke patients with low LDL-C at baseline is not well defined.”

Kim and his team examined ischaemic stroke patients with baseline LDL-C <100 mg/dL without prior statin or <70 mg/dL with prior statin therapy who were hospitalized between 2011 and 2020.

Using multivariable Cox regression analyses, the researchers assessed the effect of poststroke statin therapy on major vascular events, defined as a composite of recurrent stroke, myocardial infarction, and all-cause death within 1 year after stroke.

A total of 3,350 patients (mean age 68.6 years, 62.9 percent male) were included in the analysis. Of these, 21.5 percent had previous statin therapy and 37.0 percent had atherosclerotic stroke. Participants had mean baseline LDL-C of 73.6 mg/dL. Those with or without poststroke statin therapy had similar LDL-C levels at baseline (74.0 vs 73.4 mg/dL). [ISC 2023, abstract TMP104]

Majority of the patients (n=2,638, 78.8 percent) received statin therapy following stroke. LDL-C significantly decreased in those who were treated with statins (65.9 mg/dL in statin users vs 80.2 mg/dL in statin nonusers).

Poststroke statin therapy showed a significant association with a reduction in the risk of major vascular events (adjusted hazard ratio, 0.37, 95 percent confidence interval [CI], 0.31‒0.46).

On the other hand, poststroke LDL-C reduction (aHR, 1.00, 95 percent CI, 0.995‒1.01), percent LDL-C reduction (aHR, 0.999, 95 percent CI, 0.996‒1.003), and achieved LDL-C <55 mg/dL after stroke (aHR, 0.96, 95 percent CI, 0.67‒1.37) did not correlate with the occurrence of major vascular events within 1 year following stroke.

In a recent meta-analysis of 11 randomized controlled trials, which included a total of 20,163 patients, the findings suggested more favourable benefits and risks of more intensive LDL-C-lowering statin-based therapies for recurrent stroke risk reduction than those of less intensive therapies, especially for patients with evidence of atherosclerosis. [JAMA Neurol 2022;79:349-358]

Specifically, more intensive LDL-C-lowering statin-based therapies resulted in a lower risk of recurrent stroke in trials with all patients having evidence of atherosclerosis (relative risk [RR], 0.79, 95 percent CI, 0.69‒0.91), but not in trials with most patients not having evidence of atherosclerosis (RR, 0.95, 95 percent CI, 0.85‒1.07; p=0.04 for interaction), compared with less intensive therapies.

In another study, statin therapy in combination with ezetimibe consistently lowered cardiovascular events risk in patients with acute coronary syndrome, regardless of baseline LDL-C values. [J Am Coll Cardiol 2021;78:1499-1507]