Effect of Statin Therapy on Cardiovascular Outcome in Stroke Patients with Low Baseline Low-Density Lipoprotein Cholesterol

Objectives: To investigate whether post-stroke statin therapy reduces subsequent major vascular events in statin-naive patients with pretreatment low-density lipoprotein cholesterol (LDL-C) below the recommended target (<= 70 mg/dL for atherosclerotic stroke and <= 100 mg/dL for non-atherosclerotic stroke) at stroke onset. Methods: Patients from an ongoing stroke registry who had an ischemic stroke between 2011 and 2020 were screened. Statin naive patients with baseline LDL-C below the target were assessed. The effect of post-stroke statin therapy on major vascular events (composite of recurrent stroke, myocardial infarction, and death) was investigated using weighted Cox regression analyses using stabilized inverse probability treatment weighting. Results: The baseline LDL-C level of the 1,858 patients (mean age 67.9 +/- 15.3 years, 61.4% men, 13.2% atherosclerotic stroke) included in the study was 75.7 +/- 17.0 mg/dL. Statins were prescribed to 1,256 (67.7%) patients (low-to-moderate intensity, 23.5%; high intensity, 44.1%). Post-stroke statin therapy was associated with a lower risk of major vascular events during 1-year follow-up (weighted hazard ratio 0.55, 95% confidence interval 0.42-0.71). In a subgroup of patients who were at very high risk of atherosclerotic cardiovascular disease with LDL-C <55 mg/dL or patients who were not at very high risk of atherosclerotic cardiovascular disease with LDL-C <70 mg/dL, post-stroke statin therapy was also associated with a reduction in major vascular events (weighted hazard ratio 0.45, 95% confidence interval 0.29-0.70). The intensity of the most beneficial statin varied by subtype of stroke. Interpretation: Statin therapy may improve vascular outcomes after ischemic stroke, even in cases of LDL-C below the target without pre-stroke lipid-lowering therapy. ANN NEUROL 2024