Statin therapy in acute ischemic stroke Time for large randomized trials?

Despite improvements in stroke mortality coupled with therapeutic advances, stroke patients often face the prospect of substantial disability. Novel strategies are clearly needed to further improve stroke outcomes. These might include new indications for previously licensed drugs proven effective and safe in related disease processes,(1) such as statins. Unlike strong evidence supporting statin use in cardiovascular risk reduction and acute myocardial ischemia, their effects on cerebral tissue and potential benefits on stroke outcomes remain poorly understood and understudied. The only current stroke-specific indication for statin use is atorvastatin for secondary stroke prevention.(2) Recent meta-analyses found an association between prestroke statin use and good functional outcome (pooled odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.29-1.75; p < 0.001),(3) and lower mortality (pooled OR: 0.42; 95% CI: 0.21-0.82; p = 0.0108),(3-5) even in acute stroke patients treated with IV thrombolysis.(3) However, these estimates derive from relatively small observational cohorts at risk of bias.