Tags

Type your tag names separated by a space and hit enter

Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials.
Arch Intern Med. 2003 Mar 24; 163(6):669-76.AI

Abstract

BACKGROUND

Previous overviews suggested that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins), but not other lipid-lowering therapy (LLT), may reduce stroke incidence in coronary patients.

OBJECTIVE

To investigate the amplitude and sources of heterogeneity of LLT effects on stroke prevention.

METHODS

We searched the literature from 1966 to 2001 and then conducted a meta-analysis including randomized trials of primary and secondary coronary heart disease prevention, testing statins, nonstatin drugs, diet, or other interventions and providing data on stroke incidence.

RESULTS

The meta-analysis (38 trials, 83 161 patients, mean follow-up of 4.7 years) showed a significant relative risk reduction (RRR) of strokes by LLT of 17% (P<.001), without significant heterogeneity between trials and between subgroups according to either the type of prevention (primary or secondary) or the type of LLT. The most substantial effects were obtained, however, with statins (RRR, 26%). Effect model analysis showed that treatment benefit appeared constant whatever the risk of stroke, suggesting that LLT may be effective in a population with a higher risk of stroke. Weighted regression showed a significant correlation between RRR of stroke and total cholesterol levels (baseline, final, and change). Only final cholesterol allowed clear separation between benefit (RRR>0) and no effect (RRR<0) of LLT on stroke incidence, with a cutoff for benefit of 232 mg/dL (6.0 mmol/L).

CONCLUSION

Lipid-lowering therapy reduces stroke incidence in coronary patients, especially when total cholesterol level is lowered to less than 232 mg/dL (6.0 mmol/L), which explains the best results being obtained with statins.

Authors+Show Affiliations

Corvol JC
Service de Pharmacologie, Centre Hospitalo-Universitaire, Pitié-Salpêtrière, Paris, France.
Bouzamondo A
No affiliation info available
Sirol M
No affiliation info available
Hulot JS
No affiliation info available
Sanchez P
No affiliation info available
Lechat P
No affiliation info available

MeSH

Anticholesteremic AgentsAtorvastatinCholestyramine ResinClofibrateColestipolGemfibrozilHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypercholesterolemiaLovastatinMyocardial InfarctionPravastatinPyrrolesRandomized Controlled Trials as TopicRegression AnalysisRisk AssessmentRisk FactorsSimvastatinStrokeTreatment FailureTreatment Outcome

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

12639199

Citation

Corvol, Jean-Christophe, et al. "Differential Effects of Lipid-lowering Therapies On Stroke Prevention: a Meta-analysis of Randomized Trials." Archives of Internal Medicine, vol. 163, no. 6, 2003, pp. 669-76.
Corvol JC, Bouzamondo A, Sirol M, et al. Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. Arch Intern Med. 2003;163(6):669-76.
Corvol, J. C., Bouzamondo, A., Sirol, M., Hulot, J. S., Sanchez, P., & Lechat, P. (2003). Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. Archives of Internal Medicine, 163(6), 669-76.
Corvol JC, et al. Differential Effects of Lipid-lowering Therapies On Stroke Prevention: a Meta-analysis of Randomized Trials. Arch Intern Med. 2003 Mar 24;163(6):669-76. PubMed PMID: 12639199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. AU - Corvol,Jean-Christophe, AU - Bouzamondo,Anissa, AU - Sirol,Marc, AU - Hulot,Jean-Sébastien, AU - Sanchez,Paola, AU - Lechat,Philippe, PY - 2003/3/18/pubmed PY - 2003/4/4/medline PY - 2003/3/18/entrez SP - 669 EP - 76 JF - Archives of internal medicine JO - Arch Intern Med VL - 163 IS - 6 N2 - BACKGROUND: Previous overviews suggested that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins), but not other lipid-lowering therapy (LLT), may reduce stroke incidence in coronary patients. OBJECTIVE: To investigate the amplitude and sources of heterogeneity of LLT effects on stroke prevention. METHODS: We searched the literature from 1966 to 2001 and then conducted a meta-analysis including randomized trials of primary and secondary coronary heart disease prevention, testing statins, nonstatin drugs, diet, or other interventions and providing data on stroke incidence. RESULTS: The meta-analysis (38 trials, 83 161 patients, mean follow-up of 4.7 years) showed a significant relative risk reduction (RRR) of strokes by LLT of 17% (P<.001), without significant heterogeneity between trials and between subgroups according to either the type of prevention (primary or secondary) or the type of LLT. The most substantial effects were obtained, however, with statins (RRR, 26%). Effect model analysis showed that treatment benefit appeared constant whatever the risk of stroke, suggesting that LLT may be effective in a population with a higher risk of stroke. Weighted regression showed a significant correlation between RRR of stroke and total cholesterol levels (baseline, final, and change). Only final cholesterol allowed clear separation between benefit (RRR>0) and no effect (RRR<0) of LLT on stroke incidence, with a cutoff for benefit of 232 mg/dL (6.0 mmol/L). CONCLUSION: Lipid-lowering therapy reduces stroke incidence in coronary patients, especially when total cholesterol level is lowered to less than 232 mg/dL (6.0 mmol/L), which explains the best results being obtained with statins. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/12639199/Differential_effects_of_lipid_lowering_therapies_on_stroke_prevention:_a_meta_analysis_of_randomized_trials_ DB - PRIME DP - Unbound Medicine ER -