HIGH INTENSITY STATIN IN ISCHEMIC STROKE : EXPERIENCE FROM A TERTIARY CARE HOSPITAL OF PESHAWAR, PAKISTAN

Background: High intensity statins are one of the pillar of secondary stroke prevention. It has been a common practice to prescribe lower-than-recommended statin doses because of concerns regarding drug toxicity in Asians population. This necessitates investigation rather than assumption. Objective of this study was to determine the short term effect of high intensity statins in secondary prevention of stroke in terms of low density lipoprotein (LDL) reduction and frequency of myopathy. Materials & Methods: A Prospective observational study was conducted in Rehman Medical Institute, Peshawar. patient diagnosed with ischemic stroke, were prescribed high intensity Atrovastatin and rusuvastatin. Baseline modified Rankin Scale along with Creatinine phosphate kinase (CPK), Thyroid stimulating hormone (TSH), Alanine transaminase (ALT) and renal profile were recorded. Patients followed up after 6weeks. On follow up symptoms and signs of myopathy along with serum CPK level were recorded. The patients having myopathy were categorized as per SRM classification. Results: A total of 202 patients, 13 fail to follow up. Among the 189 patients included 59.8% (113) were males whereas (40.2%) 76 were females. The Mean LDL (low density lipoprotein) at admission was 121.43 +/- 21.56 mg/ dL. Of all, 51.9% of the participants received 40 milligrams of atorvastatin. At 6 weeks follow-up The Mean Low density lipoprotein LDL level were 61.12 +/- 27.29. mg/dl. No patient developed symptoms or muscle tenderness on examination. However, 4.2% (8) patients had raised CPK on follow-up and fell into Statin related myopathy (SRM) 0. None of the patients suffered from any other type of SRM. Conclusions: A very limited percentage of the participants developed mild, asymptomatic myopathy (SRM0). None got any other class of SRM. There was no significant association of myopathy with age, gender, mRs, premorbids and type of statin used. With high intensity statin we managed to achieve desired LDL levels in a significant number of patient on 6 weeks follow up.