J Clin Neurol.  2013 Jul;9(3):139-143. 10.3988/jcn.2013.9.3.139.

Effect of 20 mg/day Atorvastatin: Recurrent Stroke Survey in Chinese Ischemic Stroke Patients with Prior Intracranial Hemorrhage

Affiliations
  • 1Department of Neurology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China. lichunzhoubayer@163.com

Abstract

BACKGROUND AND PURPOSE
Treatment with atorvastatin (80 mg) in stroke secondary prevention for patients with prior intracranial hemorrhage (ICH) has been associated with a higher frequency of ICH. The aim of this study was to determine whether 20 mg/day atorvastatin is linked to stroke recurrence in Chinese ischemic stroke patients with prior ICH.
METHODS
A single-center retrospective cohort study was conducted, involving 354 cases from 395 Chinese in-patients who had ischemic stroke with prior ICH history in Beijing Chaoyang hospital from May 1, 2005 to October 31, 2010. Survivors were followed by telephone interviews for 12-60 months. Cox regression and Kaplan-Meier plot analysis were used to evaluate the effect of 20 mg/day atorvastatin on cerebral infarction and ICH recurrence.
RESULTS
The overall rate of stroke recurrence was lower in the 20 mg/day atorvastatin group (chi2=6.687, p=0.022) than in the control group. The incidence of cerebral hemorrhage was increased by 20 mg/day atorvastatin for ischemic stroke cases with a history of ICH compared to those not receiving the drug, but the difference was not significant [hazard ratio (HR)=1.097, 95% confidence interval (CI)=0.800-1.243, p=0.980]. The incidence of ischemic stroke recurrence was significantly reduced in subjects receiving atorvastatin (HR=0.723, 95% CI=0.578-0.862, p=0.028), and the mean duration of all stroke recurrences was significantly prolonged, compared with those not exposed to the drug (chi2=5.351, p=0.021). The mean duration of ICH recurrence appeared to have shortened with atorvastatin, but the difference was not significant (chi2=0.680, p=0.480), and the mean duration of cerebral infarction recurrence was significantly prolonged (chi2=8.312, p=0.004).
CONCLUSIONS
Medication with 20 mg/day atorvastatin may be beneficial in reducing ischemic stroke recurrence in ischemic stroke patients with a history of ICH and is not associated with an increased risk of ICH recurrence.

Keyword

ischemic stroke; intracranial hemorrhage history; atorvastatin; stroke recurrence

MeSH Terms

Atorvastatin Calcium
Asian Continental Ancestry Group
Cerebral Hemorrhage
Cerebral Infarction
Cohort Studies
Heptanoic Acids
Humans
Incidence
Interviews as Topic
Intracranial Hemorrhages
Pyrroles
Recurrence
Retrospective Studies
Secondary Prevention
Stroke
Survivors
Heptanoic Acids
Pyrroles

Figure

  • Fig. 1 Relationship between stroke recurrence and exposure to 20 mg/day atorvastatin in ischemic stroke patients with a history of intracranial hemorrhage (log-rank test; χ2=5.351, p=0.021).

  • Fig. 2 Relationship between ischemic stroke recurrence and exposure to 20 mg/day atorvastatin in ischemic stroke patients with a history of intracranial hemorrhage (log-rank test; χ2=8.312, p=0.004).

  • Fig. 3 Relationship between ICH recurrence and exposure to 20 mg/day atorvastatin in ischemic stroke patients with a history of lobar hemorrhage (log-rank test; χ2=0.680, p=0.480). ICH: intracranial hemorrhage.


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