Taoyuan City, Taiwan—Discontinuing statins can have potentially devastating unintended effects, especially for certain stroke patients.
That’s according to a new study published in the Journal of the American Heart Association, the open access journal of the American Heart Association/American Stroke Association.
The study authors, from Chang Gung University College of Medicine in Taiwan, warn that patients who stopped using statin drugs 3 to 6 months after a first ischemic stroke had a higher risk of a second stroke. Furthermore, they report, discontinuation during that time period also was linked to higher mortality risk and greater likelihood of hospitalization.
Background information in the article notes that statin drugs lower cholesterol, which can clog arteries and lead to ischemic strokes, the most common type.
The study team looked at about 45,000 patients in the Taiwan National Health Insurance program who were prescribed a statin within 90 days of discharge after an ischemic stroke between 2001 and 2012. Participants were divided into three groups: statin-discontinued, statin-reduced, and statin-maintained. Researchers sought to estimate hazard ratios of recurrent stroke over a year in the groups that discontinued statins or reduced the statin dose, compared with patients continuously using the cholesterol-lowering drugs.
During the Day-90 to Day-180 period, 7.0% of patients were on reduced statin therapy and 18.5% were not on any statin therapy. Compared with maintained-statin intensity therapy, discontinuation of statins was associated with an increased hazard of recurrent stroke, for an adjusted hazard ratio of 1.42. The risk of death from any cause increased 37% in patients who had stopped taking the drugs.
Reduced-statin dose was not associated with an additional risk, however, for an adjusted hazard ratio of 0.94.
“Based on our findings of this large group of patients in the ‘real world,’ we believe that statins should be a lifelong therapy for ischemic stroke patients if a statin is needed to lower the patient’s cholesterol,” said lead author Meng Lee, MD, assistant professor at Chang Gung University College of Medicine in Taiwan.
Lee pointed out that recommendations by the Taiwan National Health Bureau to stop or reduce statins in stroke patients once an LDL-cholesterol level of less than 100 mg/dL or total cholesterol level of less than 160 mg/dL was achieved might have led to the discontinuation of statins for some of the patients in the study. The American Heart Association recommends intensive statin therapy for patients who have had an ischemic stroke or TIA and who have an LDL-cholesterol level of more than 100 mg/dL, but does not recommend stopping statins based on achieving a specific LDL-cholesterol level in most patients, depending on individual risk.
“Discontinuation of statin treatment in patients with ischemic stroke should be strongly discouraged in any stage, acute or chronic, of stroke,” Lee said. “Shifting to low-intensity statin therapy could be an alternative for stroke patients not able to tolerate moderate or high intensity statin therapy in the years following a stroke.”
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