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Stopping statins after stroke may increase second-stroke risk

Stopping statins after stroke may increase second-stroke risk
August 3, 2017

NEW YORK (Reuters) – Stopping cholesterol-lowering drugs soon after a stroke may increase the risk of a second stroke, according to a new study from Thailand.

People who stopped taking statin drugs within three to six months after a stroke were 42 percent more likely to have another stroke within a year, compared to people who kept taking the medication, researchers found.

"These findings suggest that providers and atherosclerotic stroke patients should not discontinue statin therapy unless there is a highly compelling reason for doing so," write Dr. Meng Lee, of Chang Gung University College of Medicine, and colleagues in the Journal of the American Heart Association.

Nearly 800,000 people in the United States have a stroke each year, according to the Centers for Disease Control and Prevention (CDC), including 610,000 who are having a stroke for the first time.

Statins include the drugs atorvastatin, known commercially as Lipitor; rosuvastatin, also known as Crestor, and simvastatin, or Zocor.

They work by inhibiting the liver's ability to produce cholesterol while also helping the liver remove existing fats in the blood, according to the CDC.

The drugs are almost universally prescribed to people who have had cardiovascular events like heart attacks or strokes. Additionally, the U.S. Preventive Services Task Force recommends the drugs to people ages 40 to 75 who don't have heart disease but who do have one or more risk factors and a 10-year risk of a heart attack or stroke of at least 10 percent.

For the new study, researchers used data from 2001-2012 from the Taiwan National Health Insurance Research Database, which includes medical information for most people in the country.

They included 45,151 people who had an ischemic stroke, which is caused by a blocked blood vessel. All were prescribed a statin within 90 days of leaving the hospital.

After three to six months, 7 percent were on a reduced statin dose and 18.5 percent had been taken off the drugs entirely.

The researchers found that 6.2 percent of people who stopped taking statins ended up with another stroke within a year, compared to 4.4 percent of those who stayed on at least a moderate dose of the drugs.

There was no significant difference in risk between those who were on a reduce statin dose and those on at least a moderate dose.

The new results jibe with previous research, said Dr. Joshua Willey, who is a specialist in vascular neurology at Columbia University Medical Center in New York.

"This would argue even in the short term - even in the first year - stopping medication could have a potential harms," said Willey, who was not involved with the new study.

He told Reuters Health that stroke patients often ask doctors about statin side effects or information they read online.

"I think the vast majority of patients in the U.S. when told why they need to do it are good at remaining on it," said Willey.