Statin Therapy in Stroke Prevention and Recovery

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Statins are medications used to reduce cholesterol in the liver and bloodstream. There are different types of cholesterol. Low-density lipoprotein, LDL, is often referred to as “bad” cholesterol. High-density lipoprotein, HDL, is known as the “good” cholesterol because it helps reduce LDL in your arteries. Triglycerides are fats in your bloodstream that can lead to plaque formation in blood vessels. Your total blood cholesterol is made up of your LDL, HDL and 20% of your triglyceride level.

Statins are most effective in reducing LDL cholesterol. Your doctor may prescribe a statin therapy if your cholesterol and triglyceride levels are elevated, since these factors are linked to heart disease and stroke.

Understanding Statins

Statins block the enzyme that helps the body manufacture mevalonate, a substance that is needed to make cholesterol. Statins also work to raise the number of LDL receptors on liver cells thus increasing the uptake and breakdown of LDL. They may slightly raise HDL (good) cholesterol and reduce triglyceride levels.

In 2022, the U.S. Preventive Services Task Force (USPSTF)released updated guidelines on the use of statins to prevent a first heart attack or stroke. The new guidelines suggest adults ages 40 to 75 who have risk factors of cardiovascular disease and a 10% or higher risk of having a heart attack or stroke within the next 10 years would benefit from statin therapy. If you have a lower risk (7.5% to 10%) of heart attack or stroke within the next 10 years, they recommend talking with your doctor about whether statin therapy would be beneficial to you.

No recommendation was provided for those over age 76. The USPSTF suggests if you fall into this category, you should work with your doctor to determine whether initiating statin therapy would be appropriate. While studies have shown the benefit of statin therapy remains the same at this age, older adults are on more medications that could interact with statins, and this age group may also have risk factors that increase the chances of heart attack or stroke.

Other groups, such as the American College of Cardiology and the American Heart Association have taken a more aggressive approach. They recommend starting statins for those ages 40 to 75 who have a 7.5% or higher risk, diabetes, or extremely high cholesterol levels.

Types of Statins

Statins are both affordable and effective. They come in tablet and capsule form and are available under many different brand and generic names. An estimated 40 million Americans take statins, making them some of the most prescribed medications. Once you begin taking a statin drug, you should continue it for life, unless weight loss or lifestyle changes reduce your cholesterol level. It is important to continue taking your medication at the dosage and manner in which it was prescribed unless your doctor tells you to stop.

Statin Side Effects

Most experts agree that statins are extremely effective in reducing fats and cholesterol in the blood, lowering the risk of heart attack and stroke. Statins are considered safe, if taken as prescribed at the recommended dosage. The U.S. Food and Drug Administration (FDA) recommends liver enzyme tests be checked before starting statin therapy. Periodic routine liver tests are not required unless symptoms such as jaundice or hyperbilirubinemia develop, or as recommended by your physician.

Statins are generally well tolerated, however, as with all medications, there are some side effects that can occur, including:

  • Muscle pain, cramps and muscle weakness are the most common side effects, happening in up to 20% of those taking the medications.
  • Headache occurs in up to 17% of patients but usually resolves once your body adjusts to the medication.
  • Fatigue is seen in a small percentage of those taking statins.
  • Nausea, vomiting and diarrhea can occur. A small number of people experience these stomach symptoms while on statins.

If you experience side effects while taking statin medications, talk with your physician. These problems may be resolved by reviewing other routine medications for statin interactions, reducing statin dose, switching to alternate day dosing, taking a break from the medication, or trying a different statin medication. It is important not to stop the medication without consulting your physician.

Statins for Prevention of Stroke

According to the American Stroke Association, stroke is the No. 5 cause of death and the leading cause of disability in the United States. Statins are just one tool used to reduce the risk of heart attack and stroke.

A heart-healthy lifestyle is a major factor in reducing ASCVD (Atherosclerotic Cardiovascular Disease). The American Heart Association has issued the following dietary guidelines to reduce the risk of heart attack and stroke:

  • A diet consisting of a wide variety of fruits and vegetables, whole grains, healthy proteins (legumes, nuts, fish and seafood).
  • Consume low-fat or nonfat dairy.
  • Eat lean unprocessed meat and poultry.
  • Aim for minimally processed foods with limited added sugars and salt.
  • Stick to liquid non-tropical vegetable oils.
  • Limit or avoid alcohol intake.
  • Avoid tobacco and nicotine.

In addition, the following recommendations can help prevent cardiovascular disease and contribute to a heart-healthy lifestyle:

  • Make routine exercise part of your day. Aim for 30 to 60 minutes of moderate aerobic exercise a day, such as walking at a brisk pace.
  • Strength training done twice weekly.
  • Maintain a healthy weight.
  • Aim for at least seven hours of quality sleep nightly.
  • Manage stress.
  • Have regular health check-ups that include blood pressure monitoring, cholesterol checks, and Type 2 diabetes screening.

If lifestyle changes are not enough to control cholesterol, or if you are at high risk for cardiovascular disease, your doctor may recommend statin therapy. Statins have been found to be effective in preventing ischemic stroke when cholesterol numbers are high and may even be prescribed when cholesterol levels are normal if you are at risk of heart disease due to high blood pressure, high blood glucose, high body-mass index, or have plaque build-up as reflected on a coronary calcium scan.

Statins for Prevention of Stroke

In addition to lowering cholesterol, statins provide additional benefits in lowering stroke risk. The drugs reduce inflammation in the circulatory system, stabilize plaque already in the arteries and help prevent clogging of arteries.

Studies have shown statin use prior to ischemic stroke can improve stroke outcome, especially in small vessel stroke. Small vessel stroke occurs when a small artery that branches off a large artery in the brain becomes obstructed.

Statins and Stroke Recovery

Statin medications are an important step in prevention of secondary stroke. Standard post-stroke therapy includes implementation of a high-intensity statin with a goal of reducing the LDL level.

Following stroke, the 2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (TIA), recommends atorvastatin 80 mg daily in patients with no known coronary artery disease, no major cardiac source of embolism and an LDL level of more than 100mg/dL. For people who have a stroke or TIA and have confirmed atherosclerosis (plaque build-up in the arteries), the goal is to use statin to lower LDL to less than 70mg/dL.

For patients already taking a maximum statin dose, ezetimibe may be added. Ezetimibe is a non-statin cholesterol lowering medication usually prescribed in combination with a statin.

Is Statin Therapy Right for You?

Before starting a statin medication, talk with your doctor about the risk/benefit of statin therapy for you. The following questions may help you determine whether statins are right for you:

  • What are my cholesterol numbers?
  • Am I at risk of heart attack or stroke?
  • Does the benefit of taking a statin outweigh the risk?
  • How will we assess whether the statin medication is working?
  • Can I stop the statin if I make lifestyle changes such as losing weight or exercising?
  • What are the potential side effects and what do I do if I experience them?
  • What follow-up care is necessary? Do I need blood tests or medical check-ups?
  • If I don’t tolerate the statin or it doesn’t work, what are the next steps?

When combined with lifestyle changes and management of other chronic conditions, statins are safe for most patients and play a key role in reducing stroke risk.

NOTE: The content of this site is for informational purposes only and should not be taken as professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any medical conditions or treatments.

The content of this site is for informational purposes only and should not be taken as professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any medical conditions or treatments.