Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment
Open accessAbstract
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.
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Routine early use of high-intensity statin therapy is associated with rapid and sustained clinical benefits.
“Data from RCTs and meta-analyses indicate that routine early use of high-intensity statin therapy is associated with rapid and sustained clinical benefits [438-442].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [440]
Statin pretreatment at transient ischaemic attack onset was associated with reduced recurrent early stroke risk in patients with carotid stenosis in a pooled data analysis.
“Statin pretreatment at TIA onset was associated with reduced recurrent early stroke risk in patients with carotid stenosis in a pooled data analysis, supporting an as-early-as-possible initiation of statins after stroke.429”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [429]
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Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., et al. (2019) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2019.08.014 · Cited by 4,854 · see citing works
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- Authors
- Merwick, Á., Albers, G. W., Arsava, E. M., Ay, H., Calvet, D., Coutts, S. B., Cucchiara, B. L., Demchuk, A. M., Giles, M. F., Mas, J.-L., Olivot, J. M., Purroy, F., Rothwell, P. M., Saver, J. L., Sharma, V. K., Tsivgoulis, G., & Kelly, P. J.
- Affiliations
- Harvard University (US)
- ORCID
- Venue
- Stroke
- Published
- 2013-10
- Volume
- 44
- Issue
- 10
- Pages
- 2814-2820
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC3871879
- OpenAlex
- W2114083140
- Cited by
- 89
- References
- 24
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 13 · 2016: 8 · 2015: 14 · 2014: 12 · 2013: 5
- FWCI
- 10.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- National University of Singapore (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Wellcome Trust (095626)
- National Institute for Health and Care Research (NF-SI-0508-10266)
- U.S. Public Health Service (R0I-N5059710)
- Canadian Institutes of Health Research (MOP-118096)
- National Institute of Neurological Disorders and Stroke (R0I- NS61572, R01NS061572)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- transient ischemic attack, carotid artery stenosis, statin therapy, ABCD2 score, antiplatelet therapy, symptomatic carotid stenosis, pleiotropy, plaque stabilization, acute coronary syndrome
- MeSH terms
- Aged, Aged, 80 and over, Brain Ischemia, Female, Humans, Male, Middle Aged, Radiography, Risk Factors, Time Factors, Carotid Stenosis, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke, Diffusion Magnetic Resonance Imaging
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