Afib and stroke

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Dini
Do you know why one has to wait so long before an ablation after a stroke? Do you have any experience with statins?

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Dini
The neuro said stroke after looking at the MRI. But that’s what I thought too, but neuro said there were 2 events a week apart.
I wonder if I can get them to update my records? Also, switched to Xarelto and am curious if it’s as good as Eliquis. I’ve had Afib for a week now, never had it this long and am curious if the different blood thinner has anything to do with the prolonged Afib.

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gloaming
Additionally, I wonder if the anticoagulant prevented several other strokes over time, different places, or helped to stave this one off for a few years.

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Dini
but I also know statins are not good.

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Ken
So, if one has an ablation and no more afib, why is there an increase in stroke risk over the normal population? I was highly symptomatic when I was in afib, so I clearly know when I am not. Maybe the increase in strokes for ablated people is because some continue to have afib, but don't know it.

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Elizabeth
So George what is your conclusion? Seems like nothing for sure.

I had a cat and when I came home from the hospital and after 3 weeks of being home, my cat got Saddle Thrombosis, a stroke, the Vet said there was nothing we could do for her and that she was in a lot of pain, so I had to put her down. She was my friend for 15 years, but it is so strange that we both got a stroke. George do you have a link to that.

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Dini
Thank you so much for the information, the neuro was very discouraging.
Do you know why one has to wait so long before an ablation after a stroke? Do you have any experience with statins?

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Ken
My CHADS2-VASc score is 2 (my age of 78). With this, should I be on a blood thinner for life?

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Ken
Avoiding a stroke is a no brainer.

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Background
In view of evidence that statin therapy increases risk of diabetes, the balance of benefit and risk of these drugs in primary prevention has become controversial. We undertook an analysis of participants from the JUPITER trial to address the balance of vascular benefits and diabetes hazard of statin use.

Methods
In the randomised, double-blind JUPITER trial, 17 603 men and women without previous cardiovascular disease or diabetes were randomly assigned to rosuvastatin 20 mg or placebo and followed up for up to 5 years for the primary endpoint (myocardial infarction, stroke, admission to hospital for unstable angina, arterial revascularisation, or cardiovascular death) and the protocol-prespecified secondary endpoints of venous thromboembolism, all-cause mortality, and incident physician-reported diabetes. In this analysis, participants were stratified on the basis of having none or at least one of four major risk factors for developing diabetes: metabolic syndrome, impaired fasting glucose, body-mass index 30 kg/m2 or higher, or glycated haemoglobin A1c greater than 6%. The trial is registered at ClinicalTrials.gov, NCT00239681.

Findings
Trial participants with one or more major diabetes risk factor (n=11 508) were at higher risk of developing diabetes than were those without a major risk factor (n=6095). In individuals with one or more risk factors, statin allocation was associated with a 39% reduction in the primary endpoint (hazard ratio [ HR ] 0·61, 95% CI 0·47–0·79, p=0·0001), a 36% reduction in venous thromboembolism (0·64, 0·39–1·06, p=0·08), a 17% reduction in total mortality (0·83, 0·64–1·07, p=0·15), and a 28% increase in diabetes (1·28, 1·07–1·54, p=0·01). Thus, for those with diabetes risk factors, a total of 134 vascular events or deaths were avoided for every 54 new cases of diabetes diagnosed. For trial participants with no major diabetes risk factors, statin allocation was associated with a 52% reduction in the primary endpoint (HR 0·48, 95% CI 0·33–0·68, p=0·0001), a 53% reduction in venous thromboembolism (0·47, 0·21–1·03, p=0·05), a 22% reduction in total mortality (0·78, 0·59–1·03, p=0·08), and no increase in diabetes (0·99, 0·45–2·21, p=0·99). For such individuals, a total of 86 vascular events or deaths were avoided with no new cases of diabetes diagnosed. In analysis limited to the 486 participants who developed diabetes during follow-up (270 on rosuvastatin vs 216 on placebo; HR 1·25, 95% CI 1·05–1·49, p=0·01), the point estimate of cardiovascular risk reduction associated with statin therapy (HR 0·63, 95% CI 0·25–1·60) was consistent with that for the trial as a whole (0·56, 0·46–0·69). By comparison with placebo, statins accelerated the average time to diagnosis of diabetes by 5·4 weeks (84·3 [SD 47·8] weeks on rosuvastatin vs 89·7 [50·4] weeks on placebo).

Interpretation
In the JUPITER primary prevention trial, the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, including in participants at high risk of developing diabetes.

Funding
AstraZeneca.