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Acetaminophen, Cholesterol Drugs May Help Fight Stroke
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In the first study, statin use seemed to be correlated with a lower risk of having a first stroke, according to a group of French researchers.
Meanwhile, another team in the Netherlands found that patients with a body temperature ranging from normal (98.6 F) to 102.2 F who received acetaminophen soon after the onset of a stroke fared better than patients who did not receive the drug.
Both studies are in the May issue of Lancet Neurology.
in the new study, French researchers reviewed 24 studies involving more than 165,000 patients. They found that for every 1 millimole per liter decrease in LDL ("bad") cholesterol brought about by using statins, the risk of stroke fell by about 21%, compared to people who did not take these drugs.
The data also suggests that statin use slows the formation of blockages in the carotid arteries, which lead from the heart to the brain.
"It crystallizes the fact that there's a direct relationship between lowering LDL and lowering the risk of stroke," said Dr. Jonathan Friedman, an associate professor of surgery and of neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine. "It's not just a matter of putting patients at risk for stroke on a statin and considering that a success, but actually being aggressive about lowering LDL and monitoring and making sure the response is as significant as you can expect. The amount that you lower the LDL actually matters. That wasn't so obvious to a lot of us," he said.
Then, there's the second study, focusing on the pain reliever acetaminophen -- best known in the United States under the brand name Tylenol. According to background information in the study, many patients having a stroke experience fever, and they tend to have poorer recovery.
"The theory is that certain cells in the brain are not getting enough blood flow, and if the temperature of the body is high, then the metabolic rate of the cells is high, and they need more blood and oxygen -- or they will die," Friedman explained. "If the person is cool, then perhaps the metabolism will slow down and [the brain cells] could live longer."
Currently, guidelines recommend using acetaminophen or a related drug in patients whose temperature is above 99.5 degrees F, although, according to the authors, there has been little evidence to show that this actually improves outcomes.
For this study, 1,400 patients were randomly assigned to receive either acetaminophen or a placebo.
The therapy was started within 12 hours of symptoms of an ischemic stroke (the most common kind) or intracerebral hemorrhage.
Although giving acetaminophen did not significantly benefit the bulk of patients, 40% of patients with body temperatures ranging from normal to 102.2 F did benefit significantly, versus only 31% of those receiving a placebo.
The study authors warned that acetaminophen should not be dispensed to all patients having a stroke. And even the finding that the drug benefits those with a certain body temperature needs to be confirmed, they added.
Friedman agreed, and said that many doctors are already providing fever-relieving medicines to stroke patients who need it.
"I do not believe that most clinicians are using acetaminophen in the short term with all patients who have stroke, [although] most physicians feel that avoiding fever in people with stroke is important, and we would use acetaminophen in those who have a fever greater than 37.5 Celsius [99.5 F]," Friedman said. "But, we lack much data on that issue, and we definitely don't give acetaminophen to every patient with a stroke."
SOURCES: Jonathan Friedman, M.D., associate professor, surgery, neuroscience and experimental therapeutics, Texas A&M Health Science Center College of Medicine, associate dean, HSC-College of Medicine Bryan, College Station campus, and director, Texas Brain and Spine Institute; May 2009, Lancet Neurology
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