Intensive statin therapy after stroke associated with higher risk of hemorrhage
No difference was found in risk of stroke recurrence between moderate- and high-intensity statin therapy, but the latter resulted in a higher risk for intracranial hemorrhage, a Chinese study found.
High-dose statin therapy may not decrease the risk of recurrence after mild, noncardiogenic ischemic stroke but may increase the risk of intracranial hemorrhage compared with moderate-intensity statin therapy, a study in China found.
Researchers conducted a multicenter prospective study of patients with mild ischemic stroke who presented within 72 hours of symptom onset. The study is a secondary report from the SEACOAST (Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischaemic Stroke: A Prospective and Multicentre Study Based on Real-World) study, which was done in eight hospitals in China. Patients admitted from September 2019 to November 2021 with acute, mild, and noncardiogenic ischemic stroke who had received intensive or moderate statin therapy in addition to antiplatelets were included. Statins were started within 24 hours of admission. Part of the study funding was provided by Bayer. Results were published July 9 in the Journal of the American Heart Association.
Data from 2,950 patients were analyzed at three months, and data from 2,764 patients were analyzed at 12 months due to loss to follow-up. Stroke recurrence was similar in the high-intensity statin and moderate-intensity statin groups (adjusted hazard ratio [HRs], 1.12 [95% CI, 0.85 to 1.49] at three months [P=0.424] and 1.08 [95% CI, 0.86 to 1.34] at 12 months [P=0.519]). High-intensity statin therapy was associated with an increased risk of intracranial hemorrhage at both time points (adjusted HRs, 1.81 [95% CI, 1.00 to 3.25] at three months [P=0.048] and 1.86 [95% CI, 1.10 to 3.16] at 12 months [P=0.021]).
The study authors wrote that in practice, a moderate dosage of statins may be appropriate for the secondary prevention of mild stroke but that a trend suggested that high-intensity statins may benefit individuals who have a history of coronary heart disease. The study findings were consistent with others from Asian countries, they noted. "Thus, a hypothesis may exist that Asian patients seem to experience less beneficial effects from high-intensity statin use regarding stroke recurrence," the authors wrote.