ADMINISTRATION of immediate-intensive statin in patients with acute cerebral ischemia from atherosclerosis did not reduce the risk of stroke within 90 days compared with delayed-intensive statin treatment. Recurrent stroke and low-quality functional outcomes are high-risk events that can occur within 90 days of an ischemic stroke or transient ischemic attack. High levels of atherogenic lipoproteins, such as low-density lipoprotein cholesterol, may be contributing factors to the risk of recurrent stroke, and previous studies have shown how the administration of intensive statin therapy can lower risk. However, there is an absence of clear recommendations for the timing of statin administration in acute stroke. Therefore, researchers assessed whether immediate-intensive statin can reduce the risk of recurrent stroke and functional outcomes in patients with acute mild ischemic stroke or transient ischemic attack.
The study utilized data from the Intensive Statin and Antiplatelet Therapy for High-Risk Intracranial or Extracranial Atherosclerosis trial. This trial was a double-blind, randomized, placebo-controlled, multicentre comprised of 222 hospitals from China. The study enrolled 6,100 patients aged 35 and 80 with mild ischemic stroke or high-risk transient ischemic attack. Participants were divided in two into an immediate-intensive statin treatment group and a delayed treatment group. The study’s primary objective was to assess new stroke development within 90 days of treatment, while the secondary efficacy outcome evaluated composite vascular events, transient ischemic attack, ischemic stroke, vascular death, and poor functional outcomes. Incidence of moderate to severe bleeding was the primary safety outcome assessed.
Findings demonstrated no significant difference in new stroke within 90 days between the immediate intensive statin group (8.1%) and the delayed group (8.4%). There was a reduction in poor functional outcomes in patients within the immediate-intensive statin (9.8%) group compared to the delayed group (11.4%). Finally, no significant difference was observed in moderate to severe bleeding in patients receiving immediate- or delayed-intensive statin intervention, 0.8% and 0.6%, respectively.
The authors concluded that administering intensive statin medication within 72 hours compared to delayed treatment had no significant impact on recurrent stroke risk but may be associated with improved functional outcomes. Therefore, the study indicates there may be the benefit of early intensive statin therapy for acute stroke patients, but the researchers highlighted the need for repeated results in a trial with functional outcome as a primary outcome.
Reference:
Gao Y et al. Immediate-or Delayed-intensive statin in acute cerebral ischemia: The INSPIRES randomized clinical trial. JAMA neurology. DOI:10.1001/jamaneurol.2024.1433
