Published Online
on August 31, 2006

A more recent version of this article appeared on October 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/10/2640    most recent 01.STR.0000240690.69406.28v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Endres, M. Articles by Laufs, U. Search for Related Content PubMed PubMed Citation Articles by Endres, M. Articles by Laufs, U. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB NITRIC OXIDE Medline Plus Health Information Statins Stroke Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Other Stroke Treatment - Medical Endothelium/vascular type/nitric oxide

Submitted on March 15, 2006
Revised on June 19, 2006
Accepted on July 31, 2006

Discontinuation of Statin Treatment in Stroke Patients

Matthias Endres MD^* and Ulrich Laufs MD

From the Klinik und Poliklinik für Neurologie (M.E.), Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany; and the Klinik für Innere Medizin III (U.L.), Universität des Saarlandes, Homburg, Germany.

^* To whom correspondence should be addressed. E-mail: matthias.endres{at}charite.de.

Background and Purpose--Statins reduce the risk for myocardial infarctions and stroke which may in part depend on cholesterol-independent (pleiotropic) vasoprotective effects. Here, we review evidence to suggest that the abrupt discontinuation of statin medication exerts negative vascular effects in patients with acute vascular events.

Summary of Review--It is increasingly recognized that statins (HMG-CoA reductase inhibitors) exert rapid cholesterol-independent effects. Cessation of statin treatment confers overshoot activation of heterotrimeric G-proteins Rho and Rac causing production of reactive oxygen species and suppression of NO bioavailability. In humans, discontinuation of statin therapy leads to a proinflammatory, prothrombotic state with impaired endothelium function. In patients with acute coronary syndromes, abrupt discontinuation of statin therapy significantly increases morbidity and mortality, whereas in stable vascular patients discontinuation may be safe. Recent prospective data indicated that the cessation of statin medication in acute ischemic stroke patients confers a significantly higher likelihood of early neurological deterioration and poor outcome.

Conclusions--We propose that in all acute ischemic stroke patients chronically treated with statins before the event, treatment should be continued and the patient should receive medication at the day of the stroke.

Key words: acute Rx • acute stroke • brain ischemia • cholesterol • lipids • statins • treatment

This article has been cited by other articles:

				H.-C. Diener and C. Weimar Update of secondary stroke prevention Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1718 - 1724. [Full Text] [PDF]

				N. Meier, K. Nedeltchev, C. Brekenfeld, A. Galimanis, U. Fischer, O. Findling, L. Remonda, G. Schroth, H. P. Mattle, and M. Arnold Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, May 1, 2009; 40(5): 1729 - 1737. [Abstract] [Full Text] [PDF]

				U Laufs, F Custodis, and M Bohm Who does not need a statin: too late in end-stage renal disease or heart failure? Postgrad. Med. J., April 1, 2009; 85(1002): 187 - 189. [Abstract] [Full Text] [PDF]

				S. Westphal, C. Abletshauser, and C. Luley Fluvastatin Treatment and Withdrawal: Effects on Endothelial Function Angiology, October 1, 2008; 59(5): 613 - 618. [Abstract] [PDF]

				O. Adam, H.-R. Neuberger, M. Bohm, and U. Laufs Prevention of Atrial Fibrillation With 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors Circulation, September 16, 2008; 118(12): 1285 - 1293. [Full Text] [PDF]

				U Laufs, F Custodis, and M Bohm Who does not need a statin: too late in end-stage renal disease or heart failure? Heart, September 1, 2008; 94(9): 1138 - 1140. [Abstract] [Full Text] [PDF]

				M. Rodriguez-Yanez, J. Agulla, R. Rodriguez-Gonzalez, T. Sobrino, and J. Castillo Review: Statins and stroke Therapeutic Advances in Cardiovascular Disease, June 1, 2008; 2(3): 157 - 166. [Abstract] [PDF]

				L. Mascitelli, F. Pezzetta, J. Castillo, M. Blanco, A. Davalos, and S. de Compostela STATIN TREATMENT WITHDRAWAL IN ISCHEMIC STROKE: A CONTROLLED RANDOMIZED STUDY Neurology, May 6, 2008; 70(19): 1720 - 1721. [Full Text] [PDF]

				J. Ponce, N. P. de la Ossa, O. Hurtado, M. Millan, J. F. Arenillas, A. Davalos, and T. Gasull Simvastatin Reduces the Association of NMDA Receptors to Lipid Rafts: A Cholesterol-Mediated Effect in Neuroprotection Stroke, April 1, 2008; 39(4): 1269 - 1275. [Abstract] [Full Text] [PDF]

				V. Prinz, U. Laufs, K. Gertz, G. Kronenberg, M. Balkaya, C. Leithner, U. Lindauer, and M. Endres Intravenous Rosuvastatin for Acute Stroke Treatment: An Animal Study Stroke, February 1, 2008; 39(2): 433 - 438. [Abstract] [Full Text] [PDF]

				F. Colivicchi, A. Bassi, M. Santini, and C. Caltagirone Discontinuation of Statin Therapy and Clinical Outcome After Ischemic Stroke Stroke, October 1, 2007; 38(10): 2652 - 2657. [Abstract] [Full Text] [PDF]