Nirali Vora, MD
True or false; stroke = statin? Current AHA guidelines support statin therapy for secondary stroke prevention presumed related to atherosclerosis. It is technically not recommended for cardioembolic stroke. The seminal secondary stroke prevention and statin trial, SPARCL, excluded pateints with cardioembolic stroke risk factors, like afib and valvular heart disease. Other observational studies have shown benefit with survival and stroke recurrence when statin prescribed to all-comers no matter the etiology.
This Korean study retrospectively looked at stroke recurrence and death rates at ~22 months after first-time cardioembolic stroke patients vs. non-cardioembolic (clinical, unclear if cryptogenic patients excluded) were started on no statin, high or low dose statin. About 20% patients were lost to follow up or died.
The results were that cardio-embolic (primarily AF) stroke patients started on statins independent of dose had lower rates of mortality compared to those not on a statin. However, stroke recurrence rates were unchanged. So, statins = survival?
Interestingly, the effect of statins on mortality was independent of CAD risk factors, and those patients with vascular risk factors who had lower LDLs without statin therapy did not have better mortality. The authors posit that statins may be reducing mortality by another mechanism beyond lipid lowering effects. This may result in statin benefit to strokes from more than just atherosclerotic etiologies.