Abstract TP203: Annual Population Burden Of Major Adverse Event From Statin Overuse In Acute Cerebral Ischemia Patients Without Indications

Abstract

Background: Statin agents play a major role in secondary prevention after acute cerebral ischemia (ACI) events but are not indicated in all ischemic stroke and TIA patients. National guidelines recommend statins for patients: 1) with ACI of large or small vessel atherosclerotic origin; and 2) without these stroke mechanisms, but co-existing CAD or primary prevention indications. The potential adverse effects of statin overuse in the remaining ACI patients has not been well delineated. Methods: Per PRISMA guidelines, we performed systematic meta-analyses of: 1) statin RCTs to determine absolute risk increases for 6 major adverse events; and 2) large clinical series to determine the proportion of ACI events due to large or small vessel atherosclerotic disease and the proportion of remaining patients with CAD/primary prevention statin indications. Results: For adverse effects, data was available from 63 RCTs enrolling 155,107 patients. Statin therapy increased the risk of occurrence of 6 conditions: diabetes, myalgia, myopathy, liver disease, renal insufficiency, and eye disease. Across 16 large series enrolling 16,161 patients, rate of ACI due to large and small artery atherosclerosis was 45.9% (LAA 19.3%, SVD 17.9%), rate of remaining patients with CAD/primary prevention statin indications 24.0%, and rate of patients without statin indication 30.0%. Data synthesis indicated that, in the US, were all ACI without statin indications treated with statins, a total of 8902 patients would develop needless adverse events each year, most commonly diabetes, myopathy, and eye disease (Table). Conclusion: Nearly one-third of acute cerebral ischemia patients do not have an indication for statins and statin overuse in these patients could annually lead to nearly 9000 needless adverse events, including diabetes, myopathy, and eye disease. These findings emphasize the importance of adhering to guideline indications for the start of statin therapy in acute cerebral ischemia.