It’s best to remain on statin post-stroke Study with a master, Sagittarius

Dear Dr. Roach: I recently had a stroke, and the hospitalist started me on 40 milligrams atorvastatin per day. My cholesterol was only borderline high with a total of 210. I am 71 years old, no family history of stroke, never smoked, normal blood pressure and not too overweight. Four weeks after starting the 40 mg per day, my total cholesterol was 130. Do I need to maintain 40 mg per day, or would it be reasonable to cut back?

Fortunately, I recovered to maybe 90% of previous functioning level in a couple of weeks. My total daily medication regimen is the 40 mg atorvastatin and an 81-mg aspirin. I asked my family physician about this, and he said something along the lines of, “Well, your numbers look pretty good so if you’re not having any muscle issues why don’t you simply continue as is.” I’d like to know what you think. — J.F.

A stroke is the death of brain cells. They can range in severity from asymptomatic to devastating. Strokes are typically the result of ischemia — literally, loss of blood flow. This can be caused by blockages of cholesterol and blood clot in the arteries; by embolus, usually a blood clot coming from somewhere else; or by hemorrhage, which is bleeding inside the brain. Hemorrhagic strokes are generally not treated with statin drugs such as atorvastatin or anti-platelet drugs like aspirin.

Multiple trials have proven that in people who have had an ischemic stroke, statin drugs reduce the risk of a second stroke. This is true even for people with cholesterol results in the normal range. Based on the trial results, high-dose statin drugs (40 mg atorvastatin) are preferred in people who are able to tolerate them. Since you haven’t reported any side effects, I would recommend you continue the highdose. It is your best chance to prevent a future stroke.

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