Statin use is associated with reduced stroke risk after cranial radiation in glioma patients with hyperlipidemia.

BACKGROUND AND OBJECTIVES: Cranial radiation is a cornerstone in management of glioma though is associated with increased stroke risk. Hyperlipidemia has previously been found to be associated with increased stroke risk in this population. This study aimed to evaluate whether statin use is associated with reduced stroke risk in patients with glioma and hyperlipidemia who underwent cranial radiation. METHODS: We conducted a retrospective study of adult patients with glioma and hyperlipidemia who received cranial radiation between 2005 and 2021. Data were collected from time of cranial radiation until last follow-up. Patients diagnosed with hyperlipidemia through review of medical records at time of stroke were included in the analysis. Cox-proportional hazards modeling was performed to evaluate incident stroke with death as a competing event to evaluate the impact of statin exposure on stroke. RESULTS: In a cohort of 297 patients that received cranial radiation and had hyperlipidemia, 65 (21.9%) experienced stroke. Increasing age at diagnosis was independently associated with higher stroke risk (HR 1.03, 95% CI 1.00-1.05, p = 0.02) while statin use was independently associated with lower risk of stroke (HR 0.36, 0.21-0.61, p < 0.001). DISCUSSION: In a cohort of glioma patients with hyperlipidemia treated with cranial radiation, statin therapy was associated with lower stroke risk. These findings suggest a potential protective effect of statins against cerebrovascular injury in radiated patients. Prospective studies are warranted to explore whether lipid management should be incorporated into cerebrovascular risk reduction strategies in neuro-oncology care.

Duke Scholars

Author Katherine Barnett Peters Neurosurgery, Neuro-Oncology

Author Nishant Shah Medicine, Cardiology

Author Dylan Thomas Ryan Neurology, Stroke and Vascular Neurology