Why aren’t more stroke survivors getting statins?

People with a history of stroke are less likely than those with heart disease to get cholesterol-lowering statin drugs despite the benefits, a recent study has found.

Statins help protect the heart and brain by preventing artery plaques — buildups of cholesterol, calcium and other substances in blood vessels — from blocking blood flow and causing a heart attack or stroke. For patients with a history of such conditions, guidelines recommend statins to lower LDL, the “bad” cholesterol.

In the study, published in the Journal of the American Heart Association, researchers examined more than 3,200 patient records from 2015. About 2,200 had heart disease, including previous heart attack or coronary bypass. About 400 had a history of cerebrovascular disease — stroke, mini-stroke or carotid artery narrowing. The rest had both heart and cerebrovascular disease.

Those with cerebrovascular disease were 36% less likely than those with heart disease to receive statin therapy, and 40% less likely to receive statins at the recommended dose. The differences persisted even after researchers accounted for factors such as age, sex, race, income and trust in health care providers.

People with both heart and cerebrovascular disease had similar statin use and intensity as those with heart disease only. The three groups did not differ in reported side effects or beliefs about statins’ safety and effectiveness or cardiovascular disease risk.

“The more LDL (cholesterol) is reduced on statin therapy, the greater benefit in terms of cardiovascular disease risk reduction,” said the study’s lead author, Dr. Ying Xian. But while 84% of all patients in the study received statins, fewer than half did at recommended levels.

Some patients don’t tolerate statins well. But other factors also might cause their underuse — such as fear the drugs could trigger a bleeding stroke, said Xian, associate professor of neurology and medicine at Duke Clinical Research Institute in Durham, North Carolina. Although that concern is debated, he said, evidence is overwhelming that any risk of such a stroke is offset by the benefit of preventing other cardiovascular diseases.

But there might be other reasons for statin underuse in people with cerebrovascular disease, said Dr. Dawn Bravata, who studies the care of such patients. Maybe they are more likely than people with heart disease to have medical circumstances that give doctors pause about aggressive cholesterol-lowering therapy, such as prior bleeding inside the skull. Bravata, a professor of medicine and adjunct professor of neurology at Indiana University School of Medicine, was not involved in the new study.

Other research also has found heart attack survivors are more likely to receive direct follow-up care than stroke survivors — and that care is linked to improved risk factor management. Perhaps primary care providers and neurologists, the doctors most likely to care for cerebrovascular patients, are less likely than cardiologists to prescribe statins as recommended, Bravata said.

To ensure appropriate prescription of statins, Xian said doctors should use risk assessment tools, discuss risks and treatments with patients, and understand their concerns.

“Patients should be more proactive about their own health,” he added. “For both healthy people and individuals who already have atherosclerotic cardiovascular disease, most people can reduce their risk through healthier lifestyle changes.”

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Stroke Rehabilitation

Making the Best Decisions at Discharge After Stroke

The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

What to Expect from Outpatient Rehab

After stroke, about two-thirds of survivors receive some type of rehabilitation. Outpatient therapy may consist of Several types of therapy. Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.

What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type rehabilitation. In this second of our two-part series, we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of the stroke recovery journey.
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AHA-ASA Resources

The Support Network

When faced with challenges recovering from heart disease or stroke, it’s important to have emotional support. That is why we created a network to connect patients and loved ones with others during their journey.

Caregiver Guide to Stroke

The Caregiver Guide to Stroke is meant to help caregivers better navigate the recovery process and the financial and social implications of a stroke.

Stroke Support Group Finder

To find a group near you, simply enter your ZIP code and a mile radius. If your initial search does not pull up any groups, try

Tips for Daily Living Library

This volunteer-powered library gathers tips and ideas from stroke survivors, caregivers and healthcare professionals all over the country who’ve created or discovered adaptive and often innovative ways to get things done!

Stroke Family Warmline

The Warmline connects stroke survivors and their families with an ASA team member who can provide support, helpful information or just a listening ear.

Let's Talk About Stroke Patient Information Sheets

Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read.

Request Free Stroke Information Packets

Fill out this online form to request free information about a variety of post-stroke topics.
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Stroke & Parts of the Brain

When Stroke Affects the Occipital Lobe

Our occipital lobe, the smallest of the four lobes of the cerebral cortex, controls how we visually interpret our world.

When Stroke Affects the Cerebellum

The cerebellum contains 80 percent of our neurons. Its job seems to be to make things better. We talked with neuroscientist Jeremy Schmahmann about how stroke affects the “little brain.”

When Stroke Affects the Parietal Lobe

The parietal lobe helps us make sense of sensory information, like where our bodies and body parts are in space, our sense of touch, and the part of our vision that deals with the location of objects.

When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
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Stroke Notes

Stroke-related news you can use about new scientific findings, public policy, programs and resources.

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Articles, poems and art submitted by stroke survivors and their loved ones.

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Everyone has a reason to live a longer, healthier life. These stroke survivors, caregivers and others share their 'whys'. We'd love for you to share yours, too!

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Life At The Curb

A unique perspective on survival by comedian and stroke survivor John Kawie.

Simple Cooking

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Helping Others Understand

Stroke affects people differently and many of the effects of stroke can be complicated. Helping friends and family understand how a stroke is affecting a survivor can help everyone involved.

Support Showcase

Our new department highlighting the good work being done by stroke support groups from around the nation. If you are part of a successful support group we should consider featuring, let us know!