Yan Hou, MD, PhD
van Dongen MME, Aarnio K, Martinez-Majander N, Pirinen J, Sinisalo J, Lehto M, et al. Use of Statins After Ischemic Stroke in Young Adults and Its Association With Long-Term Outcome. Stroke. 2019;50:3385–3392.
Young adults (aged 15 to 49) with ischemic stroke usually have a known low burden of atherosclerosis. The indication of statins to prevent recurrent stroke and other cardiovascular events is unclear in this population.
By using the database of the Social Insurance Institution of Finland, the Finnish Care Register, and Statistics Finland, young adults with first-ever ischemic stroke from the Helsinki Young Stroke Registry were followed for a median of 8.3 years. The use of statin and its association with all-cause mortality, as well as recurrent stroke or other vascular events, were assessed. Use of statin was defined as at least two purchases over the entire follow up period. Low, intermediate and high usage correspond with yearly prescription purchases of 1, 2, and ≥3, respectively.
The study found that less than half of young adults with ischemic stroke (46.8% of n=935) used statins, and 22% of young adults with ischemic stroke and dyslipidemia did not use statins at all. Higher age, dyslipidemia, heavy alcohol use, hypertension, and obesity were significantly associated with use of statins. Highest proportions of statin users were found among patients with large artery atherosclerosis or small vessel disease as the underlying cause of their stroke. Statin users exhibited lower risk of all-cause mortality (HR 0.38 [95% CI, 0.25–0.58]) and recurrent stroke (HR 0.29 [95% CI, 0.19–0.44]) than nonusers after adjustment for baseline stroke risk factors, subtype, and other confounders. The benefit of statins appeared highest in the first years after stroke, with absolute risk reductions of mortality or recurrent stroke decreasing from the first to the ninth year after stroke. Risks of other recurrent vascular events or hemorrhagic stroke were not associated with use of statins.
The primary limitation of this study is data on purchases of statins do not represent the actual intake of statins, and the use of statins does not guarantee adequate lowering of LDL and total cholesterol levels. But the study suggests that all young adults with first ever ischemic stroke may benefit from statin treatment, even if they are exposed to statins for just a relatively short period and even if they had no diagnosis of dyslipidemia or an atherosclerotic cause for their index stroke.