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Stroke. 2013 Oct;44(10):2814-20. doi: 10.1161/STROKEAHA.113.001576. Epub 2013 Aug 1.

Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment.

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From the Neurovascular Unit for Translational and Therapeutics Research, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital/Dublin Academic Medical Centre, Dublin, Ireland (Á.M., P.J.K.); Department of Neurology and Neurological Sciences, Stanford Stroke Centre, Palo Alto, CA (G.W.A., J.M.O.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.M.A., H.A.); Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, Paris, France (D.C., J.-L.M.); Department of Clinical Neurosciences, and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (S.B.C., A.M.D.); Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA (B.L.C.); Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, United Kingdom (M.F.G., P.M.R.); Stroke Unit, Department of Neurology, Hospitalt Universitari Arnau de Vilanova de Lleida and Universitat de Lleida, Biomedical Research Institute of Lleida, Lleida, Spain (F.P.); Department of Neurology, UCLA Stroke Center (J.L.S.); Division of Neurology, YLL School of Medicine, National University of Singapore and National University Hospital, Singapore, Singapore (V.K.S.); Second Department of Neurology, University of Athens, School of Medicine, Athens, Greece (G.T.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic (G.T.); and Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece (G.T.).



Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis.


We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded.


In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001; 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01; 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37; CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3; CI, 0.8-2.24; P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054).


In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.


carotid stenosis; ischemic attack, transient; statin

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