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The 10-year study of nearly 800 people who had strokes found a 35 percent lower incidence of second strokes and a 57 percent lower death rate among those who took statins compared to those who didn't, according to a report in the May 26 issue of Neurology.
The new Greek study echoes findings from an even bigger international trial, reported in 2006, called Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL).
Together, "our study and the SPARCL study have clearly shown the benefits of statins," said Dr. Sotirios Giannopolous, assistant professor of neurology at the University of Ioannina, Greece, and lead author of the new trial.
SPARCL involved more than 4,700 individuals treated for strokes or "mini-strokes" (formally called transient ischemic attacks) at 205 medical centers around the world. It found a 16 percent reduction in second strokes, as well as a 35 percent reduction in major coronary events among participants given 80 milligrams a day of a single statin, Lipitor.
In the new Greek study, Giannopolous' team found that about 8 percent of those on statins had a second stroke, compared to 16 percent of participants not taking the medications.
The new study rounded out the SPARCL results because "we have included all statins in all dosages, thus our study reveals the drug class effect," Giannopoulos said. Based on the findings, "I would recommend administration of a statin on admission to a hospital," he said.
But Giannopoulos stressed that the cholesterol-lowering activity of a statin may not be the prime cause of related reductions in stroke. "Statins have anti-inflammatory and antioxidative effects," he said, "and [they] also prevent blood clotting and stabilize plaque in the arteries. So, one of these mechanisms may help to prevent recurrent stroke."
Reports that statins can help prevent stroke recurrence are already affecting medical practice, he said. "It is almost policy here in the United States to start statin therapy after stroke, even in patients with normal cholesterol levels," Giannopoulos said.
That is true to some extent, added Dr. Gary Abrams, an associate professor of neurology at the University of California, San Francisco.
Statins are "regularly used, certainly, by stroke experts," Abrams said. "It is unclear how well it is permeating the general medical community, but as the evidence unfolds I believe use will be more widespread."
While the Greek study has "a lot of useful information, it has certain weaknesses," Abrams said. "It doesn't really provide information about which statin to use and it doesn't provide information about dosages."
But there's no clear evidence that one statin is better than another, anyway, Abrams said. "My belief is that probably any statin is better than none at all," he said. "In terms of dosage, you have to target that to certain lipid [cholesterol] levels. Which statin? That question is still open."
Abrams agreed that the exact mechanism of action is unclear. "It depends partly on lipid-lowering, partly from reducing inflammation and partly from the direct effect on blood vessels," he theorized.
SOURCES: Sotirios Giannopoulos, M.D., assistant professor, neurology, University of Ioannina, Greece; Gary Abrams, M.D., associate professor, neurology, University of California, San Francisco; May 26, 2009, Neurology
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