WASHINGTON — Maybe a stethoscope picked up a telltale sloshing inside the two large arteries that carry blood to the brain. Or maybe a brief bout of dizziness or numbness prompted a doctor call.
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About 180,000 Americans a year undergo surgery to prevent a stroke, people lucky enough to learn they're at high risk in time to take that step.
Now provocative research suggests swallowing cholesterol-lowering statin pills before going under the knife improves their odds of a good outcome — by significantly cutting the small but real danger that the operation itself can spark a stroke or even death.
It's the latest evidence that the blockbuster-selling heart drugs may protect the brain, too, in ways beyond their cholesterol effect. And while the stroke protection isn't yet proven, specialists are desperate for new ways to prevent the nation's chief cause of disability and No. 3 killer.
"I was astounded," says Dr. Bruce Perler, vascular surgery chief at The Johns Hopkins Hospital in Baltimore, who led the study.
He concludes it's reasonable for many patients to put off stroke-preventing surgery for a few weeks so they can start the pills, in hopes the protection is real.
There are 700,000 strokes a year in this country, 160,000 of them fatal.
The vast majority are caused by blocked blood flow to the brain, primarily from stiffening and narrowing of the two main arteries that run up the neck, the carotids. They fill with a yellow, fibrous plaque that eventually can choke off blood flow. Or blood clots catch on that plaque to abruptly block flow. Or bits of clot or plaque break off and move upstream, clogging smaller brain arteries.
It's often a silent threat. Spotting clogged carotids can be difficult before someone suffers either a mini-stroke or a full-blown brain attack.
But when patients are caught in time, surgeons can prevent a stroke by cutting open the artery and removing clogs to restore normal blood flow. This "carotid endarterectomy" is highly protective, but occasionally it triggers strokes by loosening debris that lodges in the brain.
Enter the statins, heart drugs that sell under such names as Lipitor and Pravachol.
Perler and colleagues tracked 1,556 patients who had undergone carotid endarterectomy at Hopkins over 10 years. Forty-two percent had used statins for some other reason for at least a week before the operation — and that drug use proved remarkably protective.
Just 1.2 percent of statin users suffered a post-surgery stroke compared with 4.5 percent of patients not on the pills. More dramatic: Fewer than half a percent of statin users died post-operatively compared with 2.1 percent of nonusers, a sevenfold reduction.
Checking for other explanations, researchers found the protection persisted even though statin users had significantly more cardiovascular risk factors, they report in this month's Journal of Vascular Surgery.
Emerging role of statins
Why would the drugs help? After all, cholesterol levels don't affect the operation's immediate outcome — and many stroke sufferers don't have high cholesterol anyway.
"Statins don't just lower cholesterol," explains Perler, who said he has no financial affiliation with any statin maker.
They also seem to stabilize fibrous plaque so it's less likely to break apart and influence cells lining artery walls to lower inflammation and clot formation.
Indeed, the American Stroke Association last year advised that most patients who had survived either a stroke or mini-stroke, known as a transient ischemic attack, could benefit from statins. It cited studies that found statins reduced risk of another stroke by about 20 percent — and that benefits persisted even in patients without high cholesterol or heart disease.
"This is certainly very exciting, intriguing data that fits with what we know about the emerging role of statins in stroke prevention," says Dr. Chelsea S. Kidwell, stroke chief at the Washington Hospital Center and an associate neurology professor at Georgetown University.
One big problem: The Hopkins study couldn't determine how long someone would have to take a statin, or at what dose, to gain the protection. To prove the effect, researchers would have to randomly assign patients to use statins or a placebo for different periods before carotid surgery, something not yet planned.
Nor are statins without side effects: High doses, particularly taken for a long time, can lead to rare kidney or muscle problems.
Still, few carotid surgeries are done on an emergency basis, meaning there's time for candidates to ask their doctors whether they should try a possibly protective course of the drug.
Personally, "I'd put it off a couple of weeks to start a statin," Perler says.
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