High-Dose Statin for Every Stroke
The Good, the Bad, and the Unknown
Statins exert neuroprotective, microvascular, and anti-inflammatory beneficial effects in animal stroke models, independent of their lipid-lowering capabilities. These are seen at the highest doses with a dose–response effect. Observational studies show that statin use is associated with improved outcome in patients with ischemic stroke, presumably a result of the pleiotropic effects suggested in animal studies. This prompted an ongoing debate as to whether statins should be used in every patient with ischemic stroke regardless of the stroke mechanism and whether maximum doses should be used on initiation of therapy. Our experts firmly hold opposing and widely divergent views.
So, let us address the following questions. Is there sufficient evidence that statins have neuroprotective effects in patients with stroke? First, we point out that interpretation of clinical studies linking statins to improved stroke outcome, which were mostly retrospective, is difficult due to variability in patient population and follow-up periods and insufficient power to fully adjust for confounding variables. Few randomized trials of statins in acute stroke have been performed with inconclusive results. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, while it demonstrated the benefit of high-dose atorvastatin for secondary stroke prevention, it did not provide …