Statins and Stroke: Current Clinical Practice
To the Editor:
The role of statins on secondary prevention of stroke is not still defined. Though statins have demonstrated to reduce the relative risk of ischemic stroke by between 18% and 51% in patients with previous coronary heart disease (CHD) or high vascular disease risk, this is not clear for all stroke patients.1 An ongoing clinical trial, SPARCL, may clarify this issue.2
In order to examine the use of statins for individuals with recent stroke in our current clinical practice, we reviewed the medical records of patients with acute stroke admitted to the Department of Neurology of the Hospital de Valme, Seville, Spain, and the Department of Internal Medicine of the Hospital de la Merced, Osuna, Seville, Spain, for a 3-year period. We included 1087 patients. Nine hundred and ninety-three cases (91.4%) were ischemic infarcts and 94 (8.6%) hemorrhages. From these ischemic cases, 182 patients (18.3%) were taking statins when discharged. The main statins used were atorvastatin (34.6%), pravastatin (34.1%), simvastatin (30.2%), and lovastatin (1%). High cholesterol level was presented in 348 patients (35%); only 165 of these patients (47.4%) received statins at discharge. CHD was present in 173 patients (17.4%), but only 44 of these patients (25.4%) were taking statins at discharge. Previous stroke-transient ischemic attack and clinical limb-ischemia was present in 274 (27.5%) and 37 (3.7%) patients respectively, and received treatment in 21.5% and 24.3%. Age was associated with a reduced odd of receiving statins (P<0.001).
Our results show major deficiencies in the delivery of lipid-lowering therapy after stroke. Though statins have been shown to have beneficial effects in patients with stroke and known CHD and in other high vascular disease risk patients,1,3 and treatment strategies based on global cardiovascular risk have demonstrated to be most effective to prevent recurrent stroke and other vascular events,1,4 only approximately one-fourth of these high-risk patients received lipid-lowering agents by the time of discharge; thus, a high proportion of people who have acute stroke and coexisting cardiovascular risk factors are undertreated.
Therefore, while long-term statin trials for secondary prevention of stroke in the typical general population are expected to finish, clear major opportunities for secondary vascular prevention in patients with acute stroke are being missing.
Our findings reinforce the need to review the use of stains after acute stroke in our current clinical practice.