Effect of Statin Therapy on Cardiovascular Outcome in Stroke Patients with Low Baseline Low‐Density Lipoprotein Cholesterol

Objectives To investigate whether post‐stroke statin therapy reduces subsequent major vascular events in statin‐naïve patients with pretreatment low‐density lipoprotein cholesterol (LDL‐C) below the recommended target (≤70 mg/dL for atherosclerotic stroke and ≤100 mg/dL for non‐atherosclerotic stroke) at stroke onset. Methods Patients from an ongoing stroke registry who had an ischemic stroke between 2011 and 2020 were screened. Statin naïve patients with baseline LDL‐C below the target were assessed. The effect of post‐stroke statin therapy on major vascular events (composite of recurrent stroke, myocardial infarction, and death) was investigated using weighted Cox regression analyses using stabilized inverse probability treatment weighting. Results The baseline LDL‐C level of the 1,858 patients (mean age 67.9 ± 15.3 years, 61.4% men, 13.2% atherosclerotic stroke) included in the study was 75.7 ± 17.0 mg/dL. Statins were prescribed to 1,256 (67.7%) patients (low‐to‐moderate intensity, 23.5%; high intensity, 44.1%). Post‐stroke statin therapy was associated with a lower risk of major vascular events during 1‐year follow‐up (weighted hazard ratio 0.55, 95% confidence interval 0.42–0.71). In a subgroup of patients who were at very high risk of atherosclerotic cardiovascular disease with LDL‐C <55 mg/dL or patients who were not at very high risk of atherosclerotic cardiovascular disease with LDL‐C <70 mg/dL, post‐stroke statin therapy was also associated with a reduction in major vascular events (weighted hazard ratio 0.45, 95% confidence interval 0.29–0.70). The intensity of the most beneficial statin varied by subtype of stroke. Interpretation Statin therapy may improve vascular outcomes after ischemic stroke, even in cases of LDL‐C below the target without pre‐stroke lipid‐lowering therapy. ANN NEUROL 2024;95:876–885