Drug combo reduces stroke severity

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Taking a three drugs to prevent strokes appears to benefit patients even if a stroke occurs, Boston-based investigators report in the journal Neurology.

Taking an antiplatelet drug, like aspirin, along with an ACE inhibitor to lower blood pressure, such as lisinopril, and a type of cholesterol-lowering drug called Statins, like lovastatin, may help prevent a stroke, but if one occurs it will still probably be less severe than if the drugs had not been used.

In an interview with Reuters Health, Dr. Magdy H. Selim from Beth Israel Deaconess Medical Center said this “small preliminary study provides a scientific rationale for combining these drugs. It shows that if patients are on these drugs even before they suffer a stroke, it makes their strokes much more mild and they can recover better.”

The study involved 179 patients who were seen within 24 hours of stroke onset. Sixty-nine were not taking any of the three drugs; 47 were taking antiplatelet therapy only; 29 were taking antiplatelets and ACE inhibitors; 14 were taking antiplatelets and Statins; and 20 were taking all three drugs.

According to Selim and colleagues, patients on triple therapy at stroke onset had less severe strokes (determined by the NIH Stroke Scale), shorter hospital stays, and better functional status upon discharge than any of the other groups of patients.

At discharge, 65 percent of patients on triple therapy showed neurologic improvement, compared with 45 percent of those taking antiplatelets plus ACE inhibitors, 43 percent of those taking antiplatelets plus Statins, 38 percent of those taking antiplatelets only and 33 percent of those taking none of the drugs.

At hospital discharge, 35 percent on triple therapy had no or only slight disability compared with 17 percent of patients in the antiplatelet plus ACE group, 14 percent in the antiplatelet plus statin group, 11 percent in the antiplatelet only group and 10 percent in the no therapy group.

Imaging studies showed that while the amount of initial brain tissue damage was roughly equal among the groups, on average, the volume of brain tissue still at risk for damage was significantly smaller among those taking triple therapy.

These three drugs may work synergistically to reduce brain tissue damage later on, Selim noted in an American Academy of Neurology statement.

The authors of a related editorial say this “important study adds to the growing evidence that Statins and ACE inhibitors may be useful as neuroprotective agents in the setting of...stroke.”

However, the study authors and editorialists caution, that these findings need to be validated in large studies before Statins and ACE inhibitors can be recommended for all people at risk for stroke or for the treatment of stroke.

SOURCE: Neurology, April 25, 2006.

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