For many patients who have suffered strokes or heart attacks, cholesterol-lowering statin drugs can help to reduce the risk. But neurologists from Loyola University Health System have warned that statins may not be appropriate for certain categories of patients.
A landmark 2006 study known as SPARCL found that statins reduced the risk of subsequent strokes by 16 percent in patients who have experienced strokes or transient ischemic attacks (mini strokes).
But the Loyola neurologists say this benefit generally applies only to patients who have experienced ischemic strokes, which are caused by blood clots in brain vessels.
And even among ischemic stroke patients, there is a small subgroup that should be placed on statin therapy only "with circumspection," wrote Dr. Murray Flaster, an associate professor in the departments of Neurology and Neurological Surgery at Loyola University Chicago Stritch School of Medicine, and colleagues.
These patients are those who have had strokes in small blood vessels, have poorly controlled high blood pressure and consume more than one drink of alcohol per day.
The picture is more varied for the 15 percent of stroke patients who have had hemorrhagic strokes (caused by bleeding on or in the brain).
There are two types of hemorrhagic stroke: aneurysmal subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH). An SAH stroke involves bleeding over the surface of the brain, while an ICH stroke involves bleeding inside the brain.
Statins have been postulated to help recovery in patients with SAH. While the jury is still out, "the overall evidence slightly favours a benefit," researchers wrote.
But high-dose statin therapy "should be avoided as routine therapy in ICH patients until the competing risks and benefits are better understood," they added.
Complicating matters further is that if a patient who is on statins experiences an SAH or ICH stroke, he or she should remain on the drugs in the short run.
"Reassessment of continuing statin utility in these patients should be considered immediately after recovery," researchers wrote.
The study appeared in the August issue of the journal Expert Review of Neurotherapeutics.