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Statins and Stroke: Current Clinical Practice

2006; Lippincott Williams & Wilkins; Volume: 37; Issue: 5 Linguagem: Inglês

10.1161/01.str.0000217462.54003.43

1524-4628

Luis Castilla‐Guerra, Antonio Espino-Montoro, María del Carmen Fernández Moreno, José Manuel López‐Chozas, María Dolores Jimérnez,

Protease and Inhibitor Mechanisms

HomeStrokeVol. 37, No. 5Statins and Stroke: Current Clinical Practice Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBStatins and Stroke: Current Clinical Practice Luis Castilla-Guerra and Antonio Espino-Montoro María del Carmen Fernandez Moreno José Manuel López-Chozas María Dolores Jimérnez Luis Castilla-GuerraLuis Castilla-Guerra Department of Internal Medicine, Hospital de la Merced, Osuna, Seville, Spain and Antonio Espino-MontoroAntonio Espino-Montoro Department of Internal Medicine, Hospital de la Merced, Osuna, Seville, Spain María del Carmen Fernandez MorenoMaría del Carmen Fernandez Moreno Department of Neurology, Hospital de Valme, Seville, Spain José Manuel López-ChozasJosé Manuel López-Chozas Department of Internal Medicine, Hospital Virgen del Rocio, Seville, Spain María Dolores JimérnezMaría Dolores Jimérnez Department of Neurology, Hospital Virgen del Rocio, Seville, Spain Originally published23 Mar 2006https://doi.org/10.1161/01.STR.0000217462.54003.43Stroke. 2006;37:1153Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 23, 2006: Previous Version 1 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.2In 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.1 Amarenco P, Tonkin AM. Statins for stroke prevention. Disappointment and hope. Circulation. 2004; 109: 44–49.LinkGoogle Scholar2 SPARCL Investigators. Design and baseline characteristics of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study. Cerebrovasc Dis. 2003; 16: 389–395.CrossrefMedlineGoogle Scholar3 Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360: 7–22.CrossrefMedlineGoogle Scholar4 Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention. JAMA. 2002; 288: 1388–1395.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Canavero I, Cavallini A, Perrone P, Magoni M, Sacchi L, Quaglini S, Lanzola G and Micieli G (2014) Clinical factors associated with statins prescription in acute ischemic stroke patients: findings from the Lombardia Stroke Registry, BMC Neurology, 10.1186/1471-2377-14-53, 14:1, Online publication date: 1-Dec-2014. Castilla Guerra L and Fernández Moreno M (2008) Prevención secundaria en pacientes con ictus isquémico: es hora de actuar, Revista Clínica Española, 10.1157/13119911, 208:5, (209-210), Online publication date: 1-May-2008. Castilla Guerra L, del Carmen Fernández Moreno M, López Chozas J and Jiménez Hernández M (2008) Statins in stroke prevention: What an internist should know, European Journal of Internal Medicine, 10.1016/j.ejim.2007.05.010, 19:1, (8-14), Online publication date: 1-Jan-2008. DeFaria Yeh D and Waters D (2008) Preventing and Treating Stroke and Transient Ischemic Attack, The American Journal of Cardiology, 10.1016/j.amjcard.2007.07.072, 101:2, (270-273), Online publication date: 1-Jan-2008. Castilla-Guerra L, Balbuena García M and del Carmen Fernández-Moreno M (2007) Estatinas en la prevención secundaria del ictus en la comunidad, Atención Primaria, 10.1157/13107726, 39:7, (373-376), Online publication date: 1-Jul-2007. Castilla Guerra L, Fernández Moreno M and Jiménez Hernández M (2007) Tratamiento con estatinas tras un ictus o un accidente isquémico transitorio. ¿Café para todos?, Medicina Clínica, 10.1157/13101170, 128:14, (559), Online publication date: 1-Apr-2007. May 2006Vol 37, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000217462.54003.43PMID: 16556875 Originally publishedMarch 23, 2006 PDF download Advertisement