It is well known that drugs that bring down the bad cholesterolin the blood (statins) can reduce the risk of a second heartattack after a first heart attack occurs. We do not know whetherthis is also true for stroke. Heart attacks happen when theheart muscle does not get enough blood and oxygen because ofa blocked blood vessel. A similar problem happens with stroke,when blood vessels to the brain are blocked. Therefore, it isreasonable to think that statins may help prevent second strokesas well.
Until recently, there was little information about whether statinscan reduce stroke risk. Lately, one new study1 did test thisquestion and found that the risk of a second stroke after afirst one was lowered by statins. However, it is not clear whetherthis is only true of the statin that was tested, or if it isan effect that can be seen with all statins.
In a study in this issue of Neurology®, the records of 794first-time stroke patients were reviewed.2 Records for all ofthese patients tracked what happened to them over the next 10years. The study team carefully recorded all of their test resultsand all of their risk factors for stroke such as smoking andhigh blood pressure. All patients had experienced a stroke,and it was up to their doctor at the time to decide whetheror not they would be treated with a statin. The choice of whichstatin to use was also made by each patient's doctor. The peoplewho got statins after a stroke were compared with those whodid not.
The use of statins reduced the risk of a second stroke by abouthalf (16.3% vs 7.5%). The risk of death was much lower in thegroup treated with statins. It did not seem to matter whichstatin patients took. Statins all work in the liver to reducecholesterol levels in the body. They also have other effectsnot directly related to cholesterol, such as reducing inflammation.While there are some differences between statins, the studyseems to suggest that any of the various medications in thisclass can show this positive effect. Some common statins areatorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin.They may have different brand names.
Importantly, the lower risk of stroke seemed to be maintainedfor as long as the statin was taken. This study also showedthat the good effect of a statin did not depend on the amountof bad fat in the blood. Even people who did not have very highcholesterol measurements seemed to benefit.
This information is helpful in telling us that statins can reducestroke risk after a stroke has occurred. If you have had a stroke,you should ask your doctor if you should take a statin. If youdo take a statin already, you should continue to take it foras long as possible to reduce the risk of another stroke.
The next step is to learn how statins reduce stroke risk. Itseems that this is more than just reducing the bad fat in theblood, but exactly how it works is still not clear. We alsoneed to know whether some people do better with the treatmentthan others so we can make better choices about who and whensomeone should get the drug.
A stroke, or brain attack, is caused by the sudden loss of bloodflow to the brain or bleeding inside the head. A stroke cancause brain cells to die. This damage can cause paralysis, speechproblems, loss of feeling, memory and reasoning problems, coma,and possibly death. Fortunately, there are effective ways toprevent stroke. If you have a stroke, seeking immediate medicalattention can help reduce your chances of death and disability.
Every year, about 780,000 people in the United States suffera stroke and about 160,000 die. Stroke is the nation's numberthree killer after heart disease and cancer. Stroke is the numberone cause of adult disability.
Stroke Is an Emergency. Call 911 immediately if you or someoneyou know experiences any of the above warning signs. Jot downthe time the symptoms started. Sometimes these warning signslast for only a few minutes and then stop. But, even if thathappens or if you feel better, call 911 for help.
RISK FACTORS FOR STROKE THAT CAN BE TREATED OR CHANGED
There are two types of stroke or brain attack. Ischemic strokeis caused by an interruption of blood flow to the brain. Hemorrhagicstroke is caused by bleeding inside the brain.
About 85% of all strokes are ischemic. Ischemic stroke can becaused by narrowing of the large arteries to the brain, alsoknown as atherosclerosis. If a clot forms in the neck vessels,pieces can break off and block a brain blood vessel. Clots mayalso form in the heart and travel by blood flow to the brainvessels, where they become lodged.
Hemorrhagic stroke is caused by the bursting of a blood vesselin the brain. It accounts for about 15% of strokes. Subarachnoidhemorrhage occurs when there are weak spots on brain arteries(aneurysms) that burst and cover the brain with blood. Bloodvessels in the brain can also burst if they are weakened byhigh blood pressure, diabetes, and aging.
Immediate medical care is critical for the person who is havinga stroke or brain attack. New treatments work only if givenwithin a few hours after the onset of a stroke. For example,a clot-busting drug must be given within 3 hours of stroke onset.
Some risk factors—age, sex, race, and a history of strokein the family—cannot be changed. However, many otherscan be controlled. Most controllable risk factors relate tothe health of the heart and blood vessels. The following canhelp prevent stroke:
Having regular medical checkups
Controlling high blood pressure
Not smoking; stopping if you do
Treating heart disease,especially an irregular heart beat calledatrial fibrillation
Improving diet: avoid excess fat, salt, and alcohol
Exercising
Controlling diabetes
Seeking immediate medical attentionfor warning signs of stroke
Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355:549–559.[Abstract/Free Full Text]
Milionis HJ, Giannopoulos S, Kosmidou M, et al. Statin therapy after first stroke reduces 10-year stroke recurrence and improves survival. Neurology 2009;72:1816–1822.[Abstract/Free Full Text]
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