Neuroprotective effect of statins ‘negligible’
MedWire News: Preoperative statin use among people undergoing coronary artery bypass graft (CABG) surgery has little impact on the postoperative risk for stroke or encephalopathy, clinical research suggests.
The study, a post hoc analysis of data on over 5000 CABG patients, appears to rule out a potential cytoprotective effect of statins, say Matthew Koenig (The Johns Hopkins Hospital, Baltimore, Maryland, USA) and team writing in the journal Neurology.
For the study, Koenig’s team obtained data on 5121 patients who underwent CABG over a 10-year period at a single institution. Preoperative statins were being used by 2788 (54%) individuals.
Ischemic stroke occurred in 166 (3.2%) patients and encephalopathy in 438 (8.6%) patients. In unadjusted analyses, statin use was associated with the combined endpoint of stroke and encephalopathy with an odds ratio (OR) of 1.053 compared with statin nonuse.
Koenig’s team then performed univariate analysis to identify risk factors for statin use; these included younger age, more use of antihypertensive and antiplatelet medications, and a lower prevalence of percutaneous coronary interventions.
These and other risk factors were then used to develop a propensity score, whereby patients were divided into quintiles of propensity for statin use. After controlling for propensity score quintile, the OR of stroke/encephalopathy in statin users was 0.958 versus nonuse.
Examination of other endpoints, including cardiovascular mortality, myocardial infarction, and length of hospital stay also failed to detect any differences between statin users and nonusers.
In their discussion the researchers note that statins have pleiotropic effects, some of which are cytoprotective. In animal models, statin administration is generally associated with improved functional outcomes after ischemic injury. In humans, by contrast, the neuroprotective effect of statins is less clear.
Koenig et al say that a randomized placebo-controlled trial would be required to determine definitively whether preoperative statin use reduces stroke after CABG. Such a trial is unlikely to occur, however, since most CABG patients have a definite indication for statins and randomizing such patients to placebo would be unethical.
“Given the negative results of this and others, it does not seem justifiable to delay a potentially life-saving procedure to initiate statins,” they conclude.
In an accompanying editorial, Larry Goldstein (Duke Stroke Center, Durham, North Carolina) and Jose Suarez (Baylor College of Medicine, Houston, Texas) said that the study “provides no evidence that statins reduce post-CABG stroke and suggests that the drug class’ cytoprotective effects, if they exist, may be negligible in this setting.”
They concluded: “The quest for the ‘Holy Grail’ of a clinically effective ischemic stroke cytoprotective agent continues.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
By Joanna Lyford