Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment

Áine Merwick, Gregory W. Albers, Ethem M. Arsava, Hakan Ay, David Calvet, Shelagh B. Coutts, Brett L. Cucchiara, Andrew M. Demchuk, Matthew F. Giles, Jean Louis Mas, Jean Marc Olivot, Francisco Purroy, Peter M. Rothwell, Jeffrey L. Saver, Vijay K. Sharma, Georgios Tsivgoulis, Peter J. Kelly

Research output: Contribution to journalArticle

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Abstract

Background and Purpose-Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. Methods-We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. Results-In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37 CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3 CI, 0.8-2.24 P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). Conclusions-In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.

Original languageEnglish (US)
Pages (from-to)2814-2820
Number of pages7
JournalStroke
Volume44
Issue number10
DOIs
StatePublished - Oct 1 2013

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Carotid Stenosis
Transient Ischemic Attack
Stroke
Confidence Intervals
Therapeutics
Acute Coronary Syndrome
Odds Ratio
Blood Vessels
Pathologic Constriction
Logistic Models
Smoking

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Merwick, Á., Albers, G. W., Arsava, E. M., Ay, H., Calvet, D., Coutts, S. B., ... Kelly, P. J. (2013). Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment. Stroke, 44(10), 2814-2820. https://doi.org/10.1161/STROKEAHA.113.001576

Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment. / Merwick, Áine; Albers, Gregory W.; Arsava, Ethem M.; Ay, Hakan; Calvet, David; Coutts, Shelagh B.; Cucchiara, Brett L.; Demchuk, Andrew M.; Giles, Matthew F.; Mas, Jean Louis; Olivot, Jean Marc; Purroy, Francisco; Rothwell, Peter M.; Saver, Jeffrey L.; Sharma, Vijay K.; Tsivgoulis, Georgios; Kelly, Peter J.

In: Stroke, Vol. 44, No. 10, 01.10.2013, p. 2814-2820.

Research output: Contribution to journalArticle

Merwick, Á, Albers, GW, Arsava, EM, Ay, H, Calvet, D, Coutts, SB, Cucchiara, BL, Demchuk, AM, Giles, MF, Mas, JL, Olivot, JM, Purroy, F, Rothwell, PM, Saver, JL, Sharma, VK, Tsivgoulis, G & Kelly, PJ 2013, 'Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment', Stroke, vol. 44, no. 10, pp. 2814-2820. https://doi.org/10.1161/STROKEAHA.113.001576
Merwick, Áine ; Albers, Gregory W. ; Arsava, Ethem M. ; Ay, Hakan ; Calvet, David ; Coutts, Shelagh B. ; Cucchiara, Brett L. ; Demchuk, Andrew M. ; Giles, Matthew F. ; Mas, Jean Louis ; Olivot, Jean Marc ; Purroy, Francisco ; Rothwell, Peter M. ; Saver, Jeffrey L. ; Sharma, Vijay K. ; Tsivgoulis, Georgios ; Kelly, Peter J. / Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment. In: Stroke. 2013 ; Vol. 44, No. 10. pp. 2814-2820.
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abstract = "Background and Purpose-Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. Methods-We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. Results-In patients with carotid stenosis, 7-day stroke risk was 8.3{\%} (95{\%} confidence interval [CI], 5.7-11.1) compared with 2.7{\%} (CI, 2.0{\%}-3.4{\%}) without stenosis (P<0.0001 90-day risks 17.8{\%} and 5.7{\%} [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8{\%} (CI, 1.2{\%}-9.7{\%}) with statin treatment at TIA onset, compared with 13.2{\%} (CI, 8.5{\%}-19.8{\%}) in those not statin pretreated (P=0.01 90-day risks 8.9{\%} versus 20.8{\%} [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37 CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3 CI, 0.8-2.24 P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). Conclusions-In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.",
author = "{\'A}ine Merwick and Albers, {Gregory W.} and Arsava, {Ethem M.} and Hakan Ay and David Calvet and Coutts, {Shelagh B.} and Cucchiara, {Brett L.} and Demchuk, {Andrew M.} and Giles, {Matthew F.} and Mas, {Jean Louis} and Olivot, {Jean Marc} and Francisco Purroy and Rothwell, {Peter M.} and Saver, {Jeffrey L.} and Sharma, {Vijay K.} and Georgios Tsivgoulis and Kelly, {Peter J.}",
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T1 - Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment

AU - Merwick, Áine

AU - Albers, Gregory W.

AU - Arsava, Ethem M.

AU - Ay, Hakan

AU - Calvet, David

AU - Coutts, Shelagh B.

AU - Cucchiara, Brett L.

AU - Demchuk, Andrew M.

AU - Giles, Matthew F.

AU - Mas, Jean Louis

AU - Olivot, Jean Marc

AU - Purroy, Francisco

AU - Rothwell, Peter M.

AU - Saver, Jeffrey L.

AU - Sharma, Vijay K.

AU - Tsivgoulis, Georgios

AU - Kelly, Peter J.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Background and Purpose-Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. Methods-We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. Results-In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37 CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3 CI, 0.8-2.24 P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). Conclusions-In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.

AB - Background and Purpose-Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. Methods-We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. Results-In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37 CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3 CI, 0.8-2.24 P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). Conclusions-In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.

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