Expanding indications for statins in cerebral ischemia: a quantitative study.
BACKGROUND
New US Food and Drug Administration labeling in 2003 recognizes stroke and evidence of cerebrovascular disease as indicator conditions for initiating statin (simvastatin) therapy, based on results of the Heart Protection Study, thereby extending the indications for statins in stroke beyond current US and European guidelines.


OBJECTIVE
To assess the impact on clinical practice of broadening indications for statins in patients with stroke.


METHODS
Observational study.


METHODS
University hospital stroke service.


METHODS
One hundred consecutive patients with ischemic stroke and transient ischemic attack.


METHODS
Development and application of algorithms for initiating statin therapy in patients with stroke and transient ischemia abstracted from recent national and international guidelines (National Cholesterol Education Program Adult Treatment Panel III, European Joint Task Force II), Heart Protection Study entry criteria, and Heart Protection Study-based US Food and Drug Administration labeling.


METHODS
Percentages of patients who met clinical trial-validated and US Food and Drug Administration-approved criteria for initiation of statin therapy.


RESULTS
Patient age averaged 74 years (range, 35-96 years); 64% were female, and 74% were white. Stroke subtype was large-vessel atherosclerosis in 24%, cardioembolic in 44%, small-vessel atherosclerosis in 22%, and other in 10%. Twenty of 100 patients were already taking statins on admission. Guidelines for definite initiation of statin treatment were met by 48% of patients for the National Cholesterol Education Program III, 38% for the European Joint Task Force II, 92% for the Heart Protection Study, and 100% for the Food and Drug Administration.


CONCLUSIONS
Most clinically encountered patients with ischemic stroke meet clinical trial-validated criteria for initiation of statin therapy. Rigidly applying current national and international guidelines may deprive up to one half of these patients of advantages of statin therapy.
Ovbiagele
Bruce
B
Stroke Center and Department of Neurology, UCLA Medical Center, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
Kidwell
Chelsea S
CS
Saver
Jeffrey L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002545:Brain Ischemia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D002544:Cerebral Infarction / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D003710:Demography; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration / Q000592:standards
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents