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Preexisting statin use was associated with better outcomes in patients with acute ischemic stroke (AIS) from large artery atherosclerosis (LAA), an international, multicenter study showed.

in patients on a statin and taking it in the days prior to stroke than in those not taking a statin (66.7% versus 38.9%; P=0.004), , of the University of Tennessee Health Science Center in Memphis, and colleagues found.

Statin use before stroke was independently associated with favorable functional outcome using a modified Rankin Scale (mRS) score of 0-1 (odds ratio 2.44%; 95% confidence interval 1.07-5.53), the investigators reported online in Neurology.

Patients with LAA who received statins prior to the onset of AIS also had a lower risk of stroke recurrence (hazard ratio 0.11; 95% CI 0.02-0.46) at 30 days and a lower risk of 1-month mortality (HR 0.24; 95% CI: 0.08-0.75), the study showed.

"Our findings provide preliminary observational evidence underscoring a potentially beneficial effect of statins in improving early stroke outcomes in AIS patients with an underlying atherothrombotic mechanism," the researchers wrote. "This hypothesis deserves to be further tested in the setting of a randomized controlled trial."

Results from this study lend support to current American Heart Association/American Stroke Association recommendations for , pointed out the investigators. However, they emphasized, in the absence of phase III, randomized controlled trial data on the safety and efficacy of statins during the first 30 days following stroke, the observational study design and the short follow-up "does not allow us to infer any causal associations between statin pretreatment and improved outcomes in patients with acute LAA."

While this study provides "key data" and adds to the growing evidence about the benefits of statin use in AIA, "the results should be interpreted with caution because of potential residual confounding," , of the Massachusetts General Hospital Stroke Research Center in Boston, and , of the Westminster NHS Foundation Trust in London, cautioned in an accompanying editorial.

"Unlike strong evidence supporting statin use in cardiovascular risk reduction and acute myocardial ischemia, their effects on cerebral tissue and potential benefits on stroke outcomes remain poorly understood and under-studied," said the editorialists. "The only current stroke-specific indication for statin use is ," they noted.

Charidimou and Merwick agreed on "the urgent need for a large randomized clinical trial of high-dose statin treatment in the acute stroke setting."

Statin pretreatment may play a role in symptomatic and asymptomatic patients undergoing carotid endarterectomy as well as in the periprocedural and postprocedural outcomes of patients undergoing carotid artery stenting procedures, they pointed out. In addition, data from this study may have implications for the management of asymptomatic carotid disease as well as interpretive value for ongoing studies such as the , said Charidimou and Merwick.

Tsivgoulis' study prospectively evaluated 516 consecutive first-ever AIS patients with LAA from seven tertiary stroke care centers from June 2011 to June 2014. The mean age was 65 years and 60.8% were male. The median NIHSS score was 9 points. LAA was diagnosed by .

Statin pretreatment was documented in 192 (37.2%) patients. Information on the duration, dosage, and type of prestroke statin therapy was not collected, the authors noted.

In the initial unadjusted analysis, the study showed that in comparison to patients with LAA who didn't receive statin pretreatment, patients who did get statins had:

• Lower 30-day mortality (P=0.037)
• Lower 30-day recurrent stroke rates (P=0.002)
• Lower mean mRS score at 30 days (P=0.029)

Conversely, patients not pretreated with statins before stroke onset had a higher cumulative 30-day mortality than those who received statin pretreatment (10.5% versus 5.2%; P=0.039). Patients who didn't receive statin pretreatment also had a higher cumulative 30-day stroke recurrence (8% versus 1.6%, P=0.002).