Ending Statins After Stroke May Increase Risk of Death

BY JEFF EVANS

Patients who discontinue their use of statins within the first year after stroke may have a significantly increased risk of death, even in the absence of diagnosed heart disease, according to findings from a single-center observational study.

"This is the first evidence linking discontinuation of statins to increased mortality in stroke survivors without any clinical evidence of CHD," reported Dr. Furio Colivicchi of the San Filippo Neri Hospital, Rome, and his colleagues.

"The findings suggest that patient care should be improved during the transition from a hospital setting to outpatient primary care."

DISCONTINUATION OF STATINS WAS AN INDEPENDENT PREDICTOR OF ALL-CAUSE MORTALITY AT 1 YEAR; NEARLY A 3X HIGHER RISK OF DEATH.

From a consecutive series of 3,974 patients with acute stroke and who were discharged from a hospital during a 4.5-year period, the researchers selected a total of 631 patients who had no major concurrent illness, no evidence of coronary artery disease or other major cardiac conditions, and who were discharged on either atorvastatin (Lipitor) or simvastatin (Zocor).

These patients were studied to determine what effect statin discontinuation had on mortality during the first year after stroke. The 631 patients had an average age of 70 years (Stroke 2007 [Epub doi:10.1161/strokeaha.107.487017]).

In multivariate analysis, statin discontinuation was an independent predictor of all-cause mortality at 1 year; patients who discontinued statins had nearly a threefold higher risk of death than those who continued their prescription.The risk of death was highest soon after discontinuing statins and gradually decreased with time.

Of 246 patients who discontinued statin therapy during the 1-year follow-up period, 175 (71%) had no specific medical reason for discontinuation. Mild side effects, such as dyspepsia, fatigue, headache, myalgias, and an asymptomatic rise in plasma levels of liver enzymes, were the reason for discontinuation in the remaining 71 (29%) patients.

The mean time from hospital discharge to the discontinuation of statin in the patients was 49 days.

Most (80%) of the 116 deaths seen in the follow-up period were considered to be cardiovascular; the other deaths were listed as noncardiovascular (7%) or unknown (13%).

Female and older patients were found to be more likely to discontinue statin therapy than other patients, whereas diabetic patients were more likely to continue taking statins.

Besides the discontinuation of statin therapy, other factors that independently predicted an increased risk of death within 1 year of discharge included age, stroke severity on admission, and the discontinuation of antiplatelet therapy.

Dr. Colivicchi and his coinvestigators noted that "the relation between adherence to pharmacological treatments and clinical outcome is complex," so that "medication therapy discontinuation may also be correlated with individual self-care behaviors that may be directly or indirectly related to clinical outcomes."

Psychosocial factors such as poststroke depression, which may be present in 20%-40% of patients, may favor a poor outcome and impede participation in rehabilitation programs, according to the researchers, who did not evaluate the impact of depression on outcomes.

"The association between discontinuation of medication therapy and adverse outcomes is likely multifactorial, and future studies should evaluate whether interventions to improve self-care behaviors and lifestyles might also influence medication persistence," they concluded.

The researchers reported nothing to disclose