Your Good Health: Hemorrhagic stroke victims should be cautious with statins

Dear Dr. Roach: I take two Aggrenox daily, plus a baby aspirin every evening, because I had minor strokes about 20 years ago.

Vasculitis was suspected, but never was definitively shown through tests. I had no other obvious risk factors. A few years ago, my cholesterol started to creep up (my LDL went from 110 to 155), so I tried 10 mg daily of Lipitor for about a month.

I had to stop because of debilitating pain. After stopping, it took me almost a year to get back to normal. My doctor has suggested that it may be worth trying a different statin due to its benefits for folks who have had a stroke.

I’m concerned about this because of my previous Lipitor experience. How much additional benefit is there to adding a statin to Aggrenox and baby aspirin? Can you cite any studies to support adding a statin?

M.H.

The best answer to this question comes from the SPARCL study, published in 2006. In this study, people with a history of stroke or TIA were randomized to a statin or a placebo (the statin in the study was 80 mg of atorvastatin, Lipitor).

Eighty-seven per cent of the study participants were taking antiplatelet medicines, such as aspirin or aspirin plus dipyridamole (Aggrenox).

In the study, subjects had LDL levels between 100 and 190. The results showed that about 13 per cent of people in the placebo group had had a stroke in the five years of the study, compared with 11 per cent in the atorvastatin group.

The study did not show an increase in the subgroup of strokes called hemorrhagic strokes, where there is bleeding in the brain, a finding which has been seen in other statin studies. The atorvastatin group also had fewer heart attacks (8.6 per cent versus 5.2 per cent) and all cardiovascular events (29 per cent versus 22 per cent).

For someone with a history of stroke or TIA who could tolerate high-dose atorvastatin, I would recommend it, based on this trial.

For someone who couldn’t tolerate atorvastatin, I would consider pravastatin, based both on other trials and on the fact that people who do poorly on atorvastatin are more likely to do well on pravastatin because of its different metabolism.

I would be very cautious, however, in a person with a history of hemorrhagic stroke.

Dear Dr. Roach: My wife’s recent fasting blood results indicated stage 3b kidney failure. Is this something you frequently encounter among 79-year-old women? Can you discuss the meaning of this test result?

F.L.

Blood tests can be used to estimate kidney function, most commonly by the glomerular filtration rate, or GFR.

This measures the ability of the kidney to filter the blood. Blood tests should be repeated to ensure stability.

This level tends to decrease as we age, but a normal level for a 79-year-old woman would be about 80, with a normal range of 60 to 100.

GFR stage 1 is normal, stage 2 is 60 to 89 (meaning a healthy 79-year-old woman is likely to be stage 2, considered a mild decrease), stage 3a is 45-59 (mild to moderate), stage 3b is 30-44 (moderate to severe), stage 4 is 15-29 (severe), and stage 5 is less than 15, which usually means that dialysis becomes life-sustaining.

In people with stage 3b kidney failure, the goal is to slow any further damage to the kidney. This means control of diabetes and blood pressure (if appropriate), and a careful look at all medicines.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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