Most recent guidelines unanimously recommend statin therapy for secondary ischaemic stroke prevention. Ambulatory patients were preferentially included into SPARCL and HPS studies.
Thanks for your valuable comment. In general, we expect a shorter life expectancy after disabling stroke. As these RCTs did not identify therapy outcomes for this patient population, the short term benefit of statin therapy may be relevant to our decision making. Now, there seem to be a difference between the outcome of the SPARCL vs the HPS studies (notwithstanding the many differences in the study design): SPARCL found a significant risk reduction in statin-treated patients in 90 days, while in HPS reduction in the rate of major vascular events was only significant over 1 year follow-up. A recent observational study: doi: 10.1161/STROKEAHA.111.627729 also found a rapid decrease in early post-stroke mortality when statin therapy was initiated during hospitalization; but gives no data on disability scores.
I doubt it. I know of no convincing evidence one way or another, but on basic principles, it would seem to be possibly detrimental to be leaching more lipid from cell membranes from the remaining brain cells.
I agree that each patient is an individual who must be assessed individually, and I am totally against putting a label like "stroke" on all patients with strokes and prescribing the same treatment for them all, i.e., I do not approve of "protocols"
My opinion is that the treatment of each patient suffering from a disabled stroke should be individually decided, although statin therapy in hyperlipidemic patients with stroke could be suggested.
I agree that each patient should be treated as an individual according that patient's individual needs, and should not be given a label, like "stroke" and treated according to a "protocol"
That's absolutely right, patients are treated as individuals and decisions are made by individuals. Protocols guide the less experienced (like me) to benefit from the experience of fellow colleagues or studies, e.g. as if I drew conclusion from the therapy outcome of thousands of ischamic stroke patients, treated or not treated with a certain drug.
Let's say this is a secondary prevention therapy of a fictional ischaemic stroke patient, haemiplegic, no significant risk of bleeding, LDL-chol. 2,3 mM, atherosclerotic plaques in the ACI, TEE and 24h ECG scheduled for next week. I am just happy to hear the rationale behind the decision making of fellow clinicians or study doctors, in the light of the aforementioned studies.