Áine Merwick1, Gregory W Albers, Ethem M Arsava, Hakan Ay, David Calvet, Shelagh B Coutts, Brett L Cucchiara, Andrew M Demchuk, Matthew F Giles, Jean-Louis Mas, Jean Marc Olivot, Francisco Purroy, Peter M Rothwell, Jeffrey L Saver, Vijay K Sharma, Georgios Tsivgoulis, Peter J Kelly. 1. From the Neurovascular Unit for Translational and Therapeutics Research, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital/Dublin Academic Medical Centre, Dublin, Ireland (Á.M., P.J.K.); Department of Neurology and Neurological Sciences, Stanford Stroke Centre, Palo Alto, CA (G.W.A., J.M.O.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.M.A., H.A.); Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, Paris, France (D.C., J.-L.M.); Department of Clinical Neurosciences, and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (S.B.C., A.M.D.); Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA (B.L.C.); Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, United Kingdom (M.F.G., P.M.R.); Stroke Unit, Department of Neurology, Hospitalt Universitari Arnau de Vilanova de Lleida and Universitat de Lleida, Biomedical Research Institute of Lleida, Lleida, Spain (F.P.); Department of Neurology, UCLA Stroke Center (J.L.S.); Division of Neurology, YLL School of Medicine, National University of Singapore and National University Hospital, Singapore, Singapore (V.K.S.); Second Department of Neurology, University of Athens, School of Medicine, Athens, Greece (G.T.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic (G.T.); and Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece (G.T.).
Abstract
BACKGROUND AND PURPOSE: Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. METHODS: We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. RESULTS: In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001; 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01; 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37; CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3; CI, 0.8-2.24; P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). CONCLUSIONS: In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.
BACKGROUND AND PURPOSE: Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. METHODS: We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. RESULTS: In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001; 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01; 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37; CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3; CI, 0.8-2.24; P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). CONCLUSIONS: In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.
Authors: G G Schwartz; A G Olsson; M D Ezekowitz; P Ganz; M F Oliver; D Waters; A Zeiher; B R Chaitman; S Leslie; T Stern Journal: JAMA Date: 2001-04-04 Impact factor: 56.272
Authors: Pierre Amarenco; Julien Bogousslavsky; Alfred Callahan; Larry B Goldstein; Michael Hennerici; Amy E Rudolph; Henrik Sillesen; Lisa Simunovic; Michael Szarek; K M A Welch; Justin A Zivin Journal: N Engl J Med Date: 2006-08-10 Impact factor: 91.245
Authors: Michael Marnane; Aine Merwick; Orla C Sheehan; Niamh Hannon; Paul Foran; Tim Grant; Eamon Dolan; Joan Moroney; Sean Murphy; Killian O'Rourke; Kevin O'Malley; Martin O'Donohoe; Ciaran McDonnell; Imelda Noone; Mary Barry; Morgan Crowe; Eoin Kavanagh; Martin O'Connell; Peter J Kelly Journal: Ann Neurol Date: 2012-03-29 Impact factor: 10.422
Authors: Philippa C Lavallée; Elena Meseguer; Halim Abboud; Lucie Cabrejo; Jean-Marc Olivot; Olivier Simon; Mikael Mazighi; Chantal Nifle; Philippe Niclot; Bertrand Lapergue; Isabelle F Klein; Eric Brochet; Philippe Gabriel Steg; Guy Lesèche; Julien Labreuche; Pierre-Jean Touboul; Pierre Amarenco Journal: Lancet Neurol Date: 2007-11 Impact factor: 44.182
Authors: Peter M Rothwell; Matthew F Giles; Arvind Chandratheva; Lars Marquardt; Olivia Geraghty; Jessica N E Redgrave; Caroline E Lovelock; Lucy E Binney; Linda M Bull; Fiona C Cuthbertson; Sarah J V Welch; Shelley Bosch; Faye C Alexander; Faye Carasco-Alexander; Louise E Silver; Sergei A Gutnikov; Ziyah Mehta Journal: Lancet Date: 2007-10-20 Impact factor: 79.321
Authors: S Claiborne Johnston; Peter M Rothwell; Mai N Nguyen-Huynh; Matthew F Giles; Jacob S Elkins; Allan L Bernstein; Stephen Sidney Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: N Asdaghi; J I Coulter; J Modi; M C Camden; A Qazi; M Goyal; T Rundek; S B Coutts Journal: AJNR Am J Neuroradiol Date: 2015-04-23 Impact factor: 3.825
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Vijay K Sharma; Christos Krogias; Robert Mikulik; Konstantinos Vadikolias; Milija Mijajlovic; Apostolos Safouris; Christina Zompola; Simon Faissner; Viktor Weiss; Sotirios Giannopoulos; Spyros Vasdekis; Efstathios Boviatsis; Anne W Alexandrov; Konstantinos Voumvourakis; Andrei V Alexandrov Journal: Neurology Date: 2016-02-24 Impact factor: 9.910
Authors: Ava L Liberman; Ali Zandieh; Caitlin Loomis; Jonathan M Raser-Schramm; Christina A Wilson; Jose Torres; Koto Ishida; Swaroop Pawar; Rebecca Davis; Michael T Mullen; Steven R Messé; Scott E Kasner; Brett L Cucchiara Journal: Stroke Date: 2017-01-11 Impact factor: 7.914
Authors: Michiel H F Poorthuis; Reinier A R Herings; Kirsten Dansey; Johanna A A Damen; Jacoba P Greving; Marc L Schermerhorn; Gert J de Borst Journal: Stroke Date: 2021-10-12 Impact factor: 7.914