NEW YORK (Reuters Health) – Statin therapy before and during acute ischemic stroke hospitalization is associated with improved poststroke survival, and going off statin therapy in the hospital is associated with worse poststroke survival, a large observational study suggests.

“Because we found a strong association between early hospital statin use and long-term survival, it seems clinically prudent to treat patients with ischemic stroke with a statin from the beginning of stroke hospitalization,” Dr. Alexander C. Flint, of Kaiser Permanente, Redwood City, California and colleagues conclude in the January 2012 issue of Stroke, available online now.

“Given the association between statin withdrawal and worsened survival, care should be taken to avoid interruption of statin therapy among patients taking a statin before hospitalization,” they advise.

It’s well known that taking a statin reduces the risk of a first or second stroke among at-risk patients. There is also some evidence that statin therapy around the time of stroke hospitalization may reduce death and improve functional outcomes.

Current guidelines recommend statin therapy for secondary stroke prevention but do not say when statin therapy should be started during hospital care of the patient with acute stroke.

Dr. Flint’s team looked into the timing issue in 12,689 patients hospitalized with ischemic stroke within the Kaiser Permanente Northern California health system between January 2000 and December 2007. “The question was not whether we should treat ischemic stroke patients with a statin — it’s clear that we should. The question instead was when the statin should be started,” Dr. Flint told Reuters Health.

The researchers found that statin use before hospital admission for ischemic stroke was associated with improved survival (hazard ratio, 0.85) over the year afterward. Statin use before and during hospitalization was associated with even better rates of survival (hazard ratio, 0.59).

Patients who started statin therapy while in the hospital had a similarly lower risk of dying in the year afterward (hazard ratio, 0.55) as those taking a statin before and during hospitalization. This suggests that the association between statin use and poststroke survival is largely explained by use during stroke hospitalization, the investigators say.

Patients taking a statin before their stroke who then stopped it while in the hospital had a substantially increased risk of dying (hazard ratio, 2.5), a finding that supports previous reports of worse outcomes with statin withdrawal at the time of hospital admission for stroke.

Survival curves showed that earlier in-hospital treatment with a statin and higher doses (> 60 mg/day) were associated with improved poststroke survival. The association between statin use and survival was not explained by confounding at the individual patient level.

“Our study,” Dr. Flint said, “makes the case that giving a statin in the hospital, as soon as possible after an ischemic stroke, may improve outcomes after the stroke. Specifically, we have seen improvements in long-term survival among in-hospital statin users, greater survival benefit among higher dose statin users, and worsened survival among patients who are taken off their statin in the hospital.”

Kaiser Permanente has a program in place called PHASE (Preventing Heart Attack and Stroke Everyday) that helps manage the cardiovascular risk factors of at-risk patients, Dr. Flint said.

“This program already helps identify appropriate patients for outpatient statin use. Based on the results of our study and additional results being submitted for publication elsewhere, we have already updated our regional order sets in our electronic medical record system to remind hospital-based physicians to start appropriate ischemic stroke patients on a statin as soon as possible during hospitalization,” he told Reuters Health.

The study was supported by the Centers for Disease Control and Prevention and the Kaiser Permanente Community Benefits Research Fund. The investigators have no relevant disclosures.

Statin Use During Ischemic Stroke Hospitalization Is Strongly Associated With Improved Poststroke Survival

Stroke 2011.