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    Coming off statins makes a second stroke ‘significantly more likely’

    3 August 2017

    Coming off statins soon after a stroke could increase the likelihood of a second stroke, according to a new study published in the Journal of the American Heart Association.

    Statins work by inhibiting the liver’s ability to produce cholesterol. People who stop taking the cholesterol reducing drugs within three to six months were found to be 42 per cent more likely to have another stroke within a year.

    The researchers analysed data from the Taiwan National Health Insurance Research Database, which includes medical information for most people of the population, including 45,151 people who had an ischemic stroke. All were prescribed statins within 90 days of leaving hospital.

    After six months, 18.5 per cent had been taken off the drugs entirely. The researchers found that 6.2 per cent of those who stopped taking the drugs had another stroke within a year, compared to 4.4 percent of those who stayed on them, even at a reduced dose.

    Dr. Meng Lee, the study’s lead author, said: ‘These findings suggest that providers and atherosclerotic stroke patients should not discontinue statin therapy unless there is a highly compelling reason for doing so.’

    Instant analysis

    We have already seen evidence on starting statins in patients who have had strokes, and this study looks specifically at stopping them. By analysing data from the Taiwan National Health Insurance Research Database (NHIRD), it reports that discontinuation of statin treatment beyond the first three months after an index ischemic stroke was associated with increased risk of recurrent stroke and all‐cause mortality at one year after statin discontinuation.

    There were some limitations to the study, not least that the information was retrospective so confounding factors may have lead to bias. However, the authors argue quite reasonably that it would be unethical to carry out a clinical trial involving stopping statins in some of these patients, as we know that they are beneficial for secondary stroke prevention. Ultimately though, this study essentially tells us to keep doing what we are doing, and encourage adherence to staton therapy in post-stroke patients.