Too many stroke patients don't get cholesterol-lowering statins to prevent further episodes, researchers say
Nearly one in every five patients hospitalized for stroke do not receive prescriptions for cholesterol-lowering statins on their discharge, despite strong evidence that the drugs can prevent further strokes, as well as heart attacks and other problems, UCLA researchers said this week. About one in 10 stroke victims suffers another stroke within a week, said Dr. Bruce Ovbiagele of the UCLA Stroke Center, and while physicians have been improving in prescribing statins to prevent these secondary strokes, more education needs to be done.
Every year, about 795,000 Americans suffer a stroke, and nearly 144,000 die from it. About 600,000 of the strokes are first strokes, and the rest are repeat events.
A 2006 study called SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) showed that giving statins to stroke victims provided major benefits. The drugs produced a 16% reduction in the risk of a subsequent stroke, a 42% reduction in the risk of major coronary events, such as heart attacks, and a 45% reduction in the need for angioplasty or bypass surgery. Current guidelines from the American Heart Assn. and the American Stroke Assn. thus recommend that stroke victims be started on a cholesterol-lowering program as soon as possible.
Ovbiagele and his colleagues studied data on 173,284 stroke patients hospitalized between January 2005 and December 2007. They reported in the journal Stroke: Journal of the American Heart Assn. that, over the entire period, 83.5 of the patients received statin prescriptions at discharge. The proportion rose from 75.7% at the beginning of the study period to 84.8% at the end, indicating that more physicians were coming into compliance with the guidelines.
Women were 13% less likely than men to receive statin prescriptions, while hospitals in the South were 34% less likely to prescribe the drugs than hospitals in the West.
The next step is to investigate why these disparities exist and determine how best to bridge them, Ovbiagele said.
-- Thomas H. Maugh II