Early and delayed statin therapy have similar effect on poststroke disability
Initiating statin therapy within 24 hours of hospitalization for an acute ischaemic stroke did not appear to affect patient disability at 90 days poststroke, according to findings of the ASSORT* trial presented at the International Stroke Conference 2017 (ISC 2017) in Houston, Texas, US.
“The present [randomized controlled trial] involving patients with less severe acute ischaemic stroke and dyslipidemia did not show any benefit of early statin therapy in functional outcome at 90 days after onset,” said study principal investigator Dr Shinichi Yoshimura from the Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
In this multicentre (13 institutions), open-label trial, 270 participants (mean age 70 years, 66 and 64 percent male in the early and delayed statin therapy groups, respectively) were randomized in a 1:1 ratio to receive atorvastatin (20 mg/day)/pitavastatin (4 mg/day)/rosuvastatin (5 mg/day) either within 24 hours of hospital admission or on day 7 of hospitalization for acute ischaemic stroke.
Participants were limited to patients with hypercholesterolaemia (serum LDL-C levels ≥100 mg/dL or on treatment for hypercholesterolaemia) who were hospitalized within 24 hours of acute atherothrombotic or lacunar ischaemic stroke.
Based on assessment using the modified Rankin scale, at 90 days poststroke, patient disability did not differ regardless of whether the patient received immediate or delayed statin treatment (adjusted odds ratio, 0.84, 95 percent confidence interval, 0.53–1.3; p=0.46). [ISC 2017, abstract LB17]
Incidence of new ischaemic stroke was also comparable between the early and delayed statin treatment arms (6.9 percent vs 4.0 percent; p=0.41), as was change in National Institutes of Health Stroke Scale (NIHSS) between baseline and day 7 (-1 vs -1; p=0.40), and overall incidence of any adverse event (23.9 percent vs 17.1 percent; p=0.22)
However, early statin therapy had a bigger impact on the reduction in LDL-C levels between baseline and day 21 compared with delayed statin treatment (-65.3 vs -51.7 mg/dL; p=0.001).
According to Yoshimura, a higher statin dose may have resulted in different findings, referring to the SPARCL** study that demonstrated a stroke- and major cardiovascular event preventive effect with atorvastatin 80 mg/day. [N Engl J Med 2006;355:549-559]
“While [this study] may not have shown that there was an effect in terms of the index stroke, ... there was a difference in terms of LDL reduction at 21 days in the early vs the delayed [arms],” said Professor Bruce Ovbiagele, Chief of Neurology at Medical University of South Carolina, US, and programme chair of ISC 2017 who moderated the press briefing.
“A key part of management after a stroke is secondary prevention, so to me ... that tells us that statin early gets you to your goal quicker which is what we want in terms of optimizing secondary prevention,” he said.