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Randomized Controlled Trial
. 2018 Mar 1;25(3):262-268.
doi: 10.5551/jat.40196. Epub 2017 Sep 16.

Pravastatin Reduces the Risk of Atherothrombotic Stroke when Administered within Six Months of an Initial Stroke Event

Naohisa Hosomi  1 , Yoji Nagai  2 , Kazuo Kitagawa  3 , Yoko Nakagawa  4 , Shiro Aoki  1 , Tomohisa Nezu  1 , Tatsuo Kagimura  4 , Hirofumi Maruyama  1 , Hideki Origasa  5 , Kazuo Minematsu  6 , Shinichiro Uchiyama  7 , Masayasu Matsumoto  1   8 ; J-STARS collaborators
Affiliations
Randomized Controlled Trial

Pravastatin Reduces the Risk of Atherothrombotic Stroke when Administered within Six Months of an Initial Stroke Event

Naohisa Hosomi et al. J Atheroscler Thromb. .

Abstract

Aims: The J-STARS study examined whether pravastatin (10 mg/day) reduces recurrence of stroke in non-cardioembolic ischemic stroke patients who were enrolled within 1 month to 3 years after initial stroke events (ClinicalTrials.gov, NCT00221104). The main results showed that the frequency of atherothrombotic stroke was low in pravastatin-treated patients, although no effect of pravastatin was found for the other stroke subtypes. We evaluated differences of early (within 6 months) or late (after 6 months) pravastatin treatment benefits on the incidence of stroke or transient ischemic attack (TIA), as well as atherothrombotic stroke and the other subtypes.

Methods: Subjects in the J-STARS study were classified into two cohorts, depending on whether they enrolled early (1 to 6 months) or late (6 months to 3 years) following initial stroke events.

Results: A total of 1578 patients (491 female, 66.2±8.5 years) were randomly assigned to either the pravastatin group (n=793; n=426 in the early cohort, n=367 in the late cohort) or the control group (n=785; n=417 in the early cohort, n=368 in the late cohort). During the follow-up of 4.9± 1.4 years, the rate of atherothrombotic stroke was lower in the pravastatin group compared to controls in the early cohort (0.24 vs. 0.88%/year, p=0.01) but not in the late cohort (0.17 vs. 0.39%/year, p=0.29). However, this difference of pravastatin effect on atherothrombotic stroke was not significantly interacted by the early or late cohort (p=0.59). The incidence rates of other stroke subtype were not different in between pravastatin and control groups despite the timing of entry.

Conclusions: Pravastatin is likely to reduce atherothrombotic stroke in patients enrolled within 6 months after stroke onset. However, the clinical efficacy for prevention of recurrent stroke was not conclusive with earlier statin treatment.

Keywords: Atherothrombotic; Cholesterol; Prevention; Statin; Stroke.

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Figures

Fig. 1.
Fig. 1.
Kaplan-Meier curves for stroke and transient ischemic attack (A) and atherothrombotic stroke (B) in subjects enrolled within 6 months and later than 6 months from both pravastatin and control groups. In subjects enrolled within 6 months of stroke onset, the incidence of atherothrombotic stroke was significantly lower in the pravastatin group compared with that in the control group (B).
See this image and copyright information in PMC

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