Cholesterol-Lowering Statins May Prevent Strokes in Young

Cholesterol-lowering drugs called statins may reduce recurrent stroke risk for younger people. “The study found that those who were treated with a statin at any time after the stroke were 77 percent less likely to experience another stroke or vascular problems compared to those not treated with a statin at all. The results were the same after adjusting for factors such as age, high blood pressure, and taking high blood pressure medication.” The results were published today by the American Academy of Neurology. While the study is small, this may mean that young people who experience a stroke may benefit from being put on a cholesterol-lowering statin. Of course, a statin is a medication and not without its own set of side effects.

It was previously known that cholesterol-lowering statins can prevent recurrent strokes in older people by lowering blood cholesterol. A new study further demonstrates that statins work similarly for younger people aged 15 to 49 even when the cause of the stroke is unknown. As part of the study, researchers looked at the medical records of 215 young people who experienced a first stroke called an ischemic stroke. These people were then followed for an average of nine years. They were divided into three groups based on atatin usage: regular use of statins, irregular use of statins and no use of statins. Results showed of the 36 patients who used statins regularly, none of them experienced a stroke again. Furthermore, only 11 percent (4 people in total) of the 36 patients who sometimes used statins experienced a stroke.  Finally, of the 143 stroke victims who never took a cholesterol-lowering statin after their stroke, 20 percent (29 people) had another stroke.

A statin is a drug that lowers excess cholesterol in the body. Extra cholesterol often deposits in the blood arteries, thereby preventing good blood supply to brain. This often results in stroke. Statins interfere with the “bad” cholesterol (LDL) production in the liver. Hence statins are also prescribed for patients suffering from heart attacks and strokes. Previous studies showed the effectiveness of statins in preventing stroke recurrence in older patients. This research further proves that statins are also effective in preventing the recurrence of stroke in younger patients even when the stroke causing factors are undetermined. This knowledge should help doctors in better prevention of strokes in young patients.

* This study was conducted at the Helsinki University Central Hospital in Finland where 1,008 patients in the age group 15 to 49 years were chosen from patients’ database. They suffered ischemic stroke once between January 1994 and May 2007.
* 696 patients were excluded because their stroke had single or multiple reasons.
* The cause of the stroke was not known for the remaining 312 patients. Among them, few patients were disregarded, as they did not have complete medical evaluations available.
* Finally 215 patients were selected who had strokes without any known cause and they also possessed complete medical evaluation records.
* Data on use of statins and any other medication was collected both from direct contact with the patients and their medical records.
* Any outcome during the study period was considered severe when stroke (according to the standard criteria) happened for the second time, sometimes even leading to death.
* Statistical analysis was performed to determine how use of statins affected further stroke occurrence.
* The study adjusted several associated factors including age, sex, lipid profile, smoking, drinking, obesity, high blood pressure, heart disease, diabetes and use of other medications.

Key Findings
* The results showed that among 215 patients, 143 were not using statins, 36 always used statins and the rest 36 used statins irregularly.
* Twenty-nine (20 percent) stroke events occurred amongst 143 patients who never used statins.
* Four (11 percent) stroke events occurred in 36 patients who used statin irregularly.
* No stroke recurrence was observed in patients who always used statins since their first stroke.
* The above observations were valid even after age, sex and other disease factors were adjusted.
* Fifty-eight percent of the patients who were on statin used Simvastatin.
* Patients who used statins had poor lipid profile like high levels of cholesterol, LDL, and triglyceride etc. They also suffered from frequent high blood pressure and heart attacks.
* Patients who never used statin, were younger, had a favorable lipid profile, and showed a low occurrence of common risk factors.

Authors agree that they did not take into account several factors. They lacked systematic data on patients’ cholesterol profile during the follow up. Therefore, the influence of lipid profile on stroke reappearance was inconclusive. Moreover, medications like lowering blood pressure etc might have contributed to the prevention of stroke recurrence. Hence, it was not confirmed whether statins alone was sufficient to prevent strokes. Further, the study dealt with only small number of statins users and did not consider the latest stroke factors that might have come up during the later phase of 13 years study period. Additional studies are warranted to evaluate these conclusions.

This study showed that use of statins prevented stroke recurrence in young patients even when the stroke causing factors remained unknown. It was quite difficult to find out the exact cause of strokes in these young patients since they had good lipid profiles and no severe suffering from high pressure and heart failures. Thus, the doctors did not prescribe them Statin probably because of its side effects. However, the results revealed that no stroke recurrence was observed only in patients who always used statins. This suggests that doctors should not hesitate to prescribe statins even for the young stroke patients.  Further research should be done at a population level addressing all the limitations of the current study for a definite conclusion.

For More Information:
Statins after ischemic stroke of undetermined etiology in young adults
Publication Journal: Neurology, July 2011
By Jukka Putaala; Elena Haapaniemi; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland



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