No Clear Benefit for Early Statin Therapy in Acute Ischemic Stroke

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The role of statin therapy in acute ischemic stroke remains uncertain.
The role of statin therapy in acute ischemic stroke remains uncertain.

Results of early statin therapy within 24 hours of hospital admission are similar to delayed statin intervention for reducing 90-day disability in patients with acute ischemic stroke, according to a multicenter, randomized trial published in Stroke.

In this trial, investigators randomly assigned patients with acute ischemic stroke and dyslipidemia in a 1:1 ratio to either statin therapy at 24 hours after admission (early, n=131) or statin therapy at 7 days after hospital admission (delayed, n=126). Investigators sought to determine the degree of patient disability at 90 days, using the modified Rankin Scale.

According to the findings, disability scores at 90 days were not significantly different among those receiving early or delayed therapy (P =.68). At 90-day follow-up, the investigators observed numerically higher deaths in the early intervention group vs the delayed group (2 vs 1, respectively); however, these differences were not statistically significant. Recurrence of ischemic stroke was 6.9% in the early therapy group vs 4.0% in the delayed group. In addition, there were no significant differences in adverse events between the 2 groups.

Patients enrolled in this study had strokes that were mild in severity, reducing the generalizability of these findings to the broader population. Because the modified Rankin Scale fails to examine mild disability, the investigators suggest statin therapy may have shown greater benefits if patients with severe disability were enrolled. In addition, the investigators recommend future studies with greater sample sizes to establish the benefit of early intervention for stroke patients.

These results indicate that the role of statin therapy in acute ischemic stroke remains uncertain, particularly "in patients with more severe disability or other causes" and during the use of intravenous tissue-type plasminogen activator or endovascular thrombectomy.

Reference

Yoshimura S, Uchida K, Daimon T; ASSORT Trial Investigator. Randomized controlled trial of early versus delayed statin therapy in patients with acute ischemic stroke: ASSORT trial (Administration of statin on acute ischemic stroke patient). Stroke. 2017;48(11):3057-3063.

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