Impact Of Hdl Cholesterol Decrease Under Statin Therapy On Stroke Mortality And Recurrence

Objective: Studies of stroke recurrence have demonstrated a clear benefit with statin therapy in secondary stroke prevention. We aimed to evaluate the impact of this therapy in our cohort. Design and Method: Ambulatory stroke patients were included in PROTEGE-ACV, a stroke secondary prevention program aimed to improve identification and management of vascular RF, evaluation of functionality, quality of life, cognitive impairment and compliance to clinical practice guidelines. Patients with severe functional impairment (Rankin >3) or life expectancy less than three years were excluded. Antihypertensives, statins and antithrombotics were initiated o continued, if previously prescribed, before discharge. Mortality and stroke recurrence were measured after three years of PROTEGE-ACV starting-up. For the purpose of the analysis, two groups were defined: bad outcome (BO) for stroke recurrence, death or lost of follow-up, and good outcome (GO) if none of these endpoints were present. Results: 413 ischemic stroke patients (48% males) were included between December 2006 and December 2009. Mean age was 76 ± 9 years for women and 72.3 ± 11 years for men (p = 0.0005). Twenty-three patients had a recurrent stroke, 22 died and 3 were lost of follow-up (BO, n = 38). There was a significant increased in the use of statins after stroke in the entire cohort (42% vs 95%, p 0.00001). There were no differences in age, sex, major risk factor profile and control before stroke, history of major cardiovascular events, homocysteine, microalbuminuria, GFR, hs-CRP, fibrinogen. Table shows differences in the univariate and multivariate analysis between patients with GO vs BO. Kaplan-Meier analysis shows a three-year survival probability of 91%.Conclusion: In contrast to published data, we found a significant decrease in HDL-c with statin therapy, with a negative influence on all-cause mortality and stroke recurrence. The impact of statins on each cholesterol subfractions must be taken into account when considering the success of lipid therapy in the secondary prevention setting.