The Japan Statin Treatment Against Recurrent Stroke (J-STARS): A Multicenter, Randomized, Open-label, Parallel-group Study.

Abstract

BACKGROUND:

Although statin therapy is beneficial for the prevention of initial stroke, the benefit for recurrent stroke and its subtypes remains to be determined in Asian, in whom stroke profiles are different from Caucasian. This study examined whether treatment with low-dose pravastatin prevents stroke recurrence in ischemic stroke patients.

METHODS:

This is a multicenter, randomized, open-label, blinded-endpoint, parallel-group study of patients who experienced non-cardioembolic ischemic stroke. All patients had a total cholesterol level between 4.65 and 6.21 mmol/L at enrollment, without the use of statins. The pravastatin group patients received 10 mg of pravastatin/day; the control group patients received no statins. The primary endpoint was the occurrence of stroke and transient ischemic attack (TIA), with the onset of each stroke subtype set to be one of the secondary endpoints.

FINDING:

Although 3000 patients were targeted, 1578 patients (491 female, age 66.2 years) were recruited and randomly assigned to pravastatin group or control group. During the follow-up of 4.9 ± 1.4 years, although total stroke and TIA similarly occurred in both groups (2.56 vs. 2.65%/year), onset of atherothrombotic infarction was less frequent in pravastatin group (0.21 vs. 0.64%/year, p = 0.0047, adjusted hazard ratio 0.33 [95%CI 0.15 to 0.74]). No significant intergroup difference was found for the onset of other stroke subtypes, and for the occurrence of adverse events.

INTERPRETATION:

Although whether low-dose pravastatin prevents recurrence of total stroke or TIA still needs to be examined in Asian, this study has generated a hypothesis that it may reduce occurrence of stroke due to larger artery atherosclerosis.

FUNDING:

This study was initially supported by a grant from the Ministry of Health, Labour and Welfare, Japan. After the governmental support expired, it was conducted in collaboration between Hiroshima University and the Foundation for Biomedical Research and Innovation.

• Authors: Naohisa Hosomi, Yoji Nagai, Tatsuo Kohriyama, Toshiho Ohtsuki, Shiro Aoki, Tomohisa Nezu, Hirofumi Maruyama, Norio Sunami, Chiaki Yokota, Kazuo Kitagawa, Yasuo Terayama, Makoto Takagi, Setsuro Ibayashi, Masakazu Nakamura, Hideki Origasa, Masanori Fukushima, Etsuro Mori, Kazuo Minematsu, Shinichiro Uchiyama, Yukito Shinohara, Takenori Yamaguchi, Masayasu Matsumoto, J-STARS Collaborators
• Journal: EBioMedicine (EBioMedicine) Vol. 2 Issue 9 Pg. 1071-8 (Sep 2015) ISSN: 2352-3964 [Electronic] Netherlands
• PMID: 26501105 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pravastatin

Topics

• Aged
• Asian People
• Brain Ischemia (complications)
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Japan
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods, statistics & numerical data)
• Pravastatin (therapeutic use)
• Proportional Hazards Models
• Recurrence
• Stroke (drug therapy, ethnology, etiology)