title: Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.).
authors.forename: Áine
authors.initials: Á
authors.lastname: Merwick
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Ethem M
authors.initials: EM
authors.lastname: Arsava
authors.forename: Hakan
authors.initials: H
authors.lastname: Ay
authors.forename: David
authors.initials: D
authors.lastname: Calvet
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.forename: Brett L
authors.initials: BL
authors.lastname: Cucchiara
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Giles
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Francisco
authors.initials: F
authors.lastname: Purroy
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: carotid stenosis; ischemic attack, transient; statin
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