Matthew Edwardson, MD

Merwick A, Albers GW, Arsava EM, Ay H, Calvet D, Coutts SB, et al. Reduction in Early Stroke Risk in Carotid Stenosis With Transient Ischemic Attack Associated With Statin Treatment. Stroke. 2013.

Evidence from the SPARCL trial shows that high-dose atorvastatin reduces recurrent stroke rates when administered in the chronic setting, yet there are few studies showing reduced stroke rates with statin use in the acute setting – a time when patients are known to have the highest risk of recurrence. Patients with symptomatic carotid disease are particularly vulnerable to early stroke recurrence. Merwick and colleagues sought to determine if statin use prior to TIA onset correlated with reduced early stroke rates in those with and without symptomatic carotid stenosis. 

Remarkably, patients with carotid stenosis taking a statin prior to TIA had dramatically reduced rates of early stroke compared to those who did not (3.8% vs. 13.2% respectively at 7 days). In contrast, no significant difference in early stroke rate was seen with pre-TIA statin use in patients without carotid stenosis.

While the authors did not have information on whether starting statin therapy early after TIA decreased early stroke rates in patients with carotid stenosis, the robust effect of pre-TIA statin use suggests this may be the case. This study lays the groundwork for future clinical trials to answer this and other related questions. It also reinforces the need for statin administration by primary care physicians for patients at risk even before significant carotid disease develops. Statins are no substitute for proven treatment like carotid endarterectomy in patients with symptomatic carotid disease. Nonetheless, if the results of this study are borne out in future trials we may one day be able to sleep better at night having our patients on statins while they await more definitive surgical intervention.