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(Stroke. 2007;38:2629.)
© 2007 American Heart Association, Inc.

Editorials

Do We Need to Assess the Effect of Treatment Withdrawal?

The Paradigm of Life-Long Prevention

François Gueyffier, MD, PhD Théodora Bejan-Angoulvant, MD

From the Inserm, CIC 201, Lyon, France; and Hôpital L Pradel, Bron Cedex, France.

Correspondence to François Gueyffier, Hôpital L Pradel, 28 Avenue doyen Lépine, 69677 Bron Cedex, France. E-mail Francois.gueyffier@chu-lyon.fr

Key Words: prevention • statins • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 2652–2657.

In this issue of Stroke, Colivicchi et al observe the impact of statin discontinuation after an ischemic stroke¹: they suggest this phenomenon is not only frequent, but also associated with a significant increase of total mortality. Usually considered as secondary, the question of treatment withdrawal becomes more and more important because of: (1) the regular increase of the number of treatments with a convincing demonstration of preventive effects; (2) the general extension of life expectancy in high income countries, which explains both a dramatic increase in the numbers of elderly, and of the length of exposure to treatment far beyond that over which their effect has been estimated; (3) the high prevalence of treatment discontinuation, as illustrated by Colivicchi.¹

Is Treatment Effect Constant Over Time?

If treatment effect were constant over time, we would expect similar effects across various ages, which is not the case for blood pressure–lowering drugs. A significant 10% to 15% decrease in total mortality has been associated with these treatments in hypertension around 60 years of age, with either diuretics² or ACE-inhibitors³ as first-line drugs. Preliminary results (both from a subgroup meta-analysis⁴ and from a specific pilot trial⁵) suggest that these same drugs are associated with a lack of benefit on mortality, if not an increase, in hypertensive patients above 80 years of age.

Assessing accurately whether treatment effect is constant over time requires performing the analyses at an individual patient level. In primary prevention with hypertension, such a meta-analysis showed unexpected . . . [Full Text of this Article]

Related Article:

Discontinuation of Statin Therapy and Clinical Outcome After Ischemic Stroke

Furio Colivicchi, Andrea Bassi, Massimo Santini, and Carlo Caltagirone
Stroke 2007 38: 2652-2657. [Abstract] [Full Text] [PDF]