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Statins for stroke prevention: disappointment and hope.

Abstract

The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nonetheless, large, long-term statin trials in patients with established CHD or at high risk for CHD have shown that statins decrease stroke incidence in these populations. Combined data from 9 trials including 70,070 patients indicated relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins. The number of strokes prevented per 1000 patients treated for 5 years in patients with CHD is 9 for statins, compared with 17.3 for antiplatelet agents. Statins have not yet been shown to reduce stroke risk in the typical general population without known CHD, nor have they been shown to prevent recurrent stroke in patients with prior stroke. Potential reasons for the effects of statins on stroke and the non-cholesterol-lowering mechanisms that may be involved are discussed. Treatment strategies based on global cardiovascular risk may be most effective. Additional studies in patients representative of the typical stroke population are needed.

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  • Authors+Show Affiliations

    ,

    Department of Neurology and Stroke Center, Bichat University Hospital and Medical School, Denis Diderot University-Paris VII, 46 rue Henri Huchard, 75018 Paris, France. amarenco@ccr.jussieu.fr

    Source

    Circulation 109:23 Suppl 1 2004 Jun 15 pg III44-9

    MeSH

    Adult
    Age Factors
    Aged
    Aged, 80 and over
    Anticholesteremic Agents
    Cardiovascular Diseases
    Cerebral Hemorrhage
    Coronary Disease
    Epidemiologic Research Design
    Female
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hypercholesterolemia
    Incidence
    Male
    Meta-Analysis as Topic
    Middle Aged
    Platelet Aggregation Inhibitors
    Randomized Controlled Trials as Topic
    Recurrence
    Risk Factors
    Stroke
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15198966

    Citation

    Amarenco, Pierre, and Andrew M. Tonkin. "Statins for Stroke Prevention: Disappointment and Hope." Circulation, vol. 109, no. 23 Suppl 1, 2004, pp. III44-9.
    Amarenco P, Tonkin AM. Statins for stroke prevention: disappointment and hope. Circulation. 2004;109(23 Suppl 1):III44-9.
    Amarenco, P., & Tonkin, A. M. (2004). Statins for stroke prevention: disappointment and hope. Circulation, 109(23 Suppl 1), pp. III44-9.
    Amarenco P, Tonkin AM. Statins for Stroke Prevention: Disappointment and Hope. Circulation. 2004 Jun 15;109(23 Suppl 1):III44-9. PubMed PMID: 15198966.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statins for stroke prevention: disappointment and hope. AU - Amarenco,Pierre, AU - Tonkin,Andrew M, PY - 2004/6/17/pubmed PY - 2004/10/19/medline PY - 2004/6/17/entrez SP - III44 EP - 9 JF - Circulation JO - Circulation VL - 109 IS - 23 Suppl 1 N2 - The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nonetheless, large, long-term statin trials in patients with established CHD or at high risk for CHD have shown that statins decrease stroke incidence in these populations. Combined data from 9 trials including 70,070 patients indicated relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins. The number of strokes prevented per 1000 patients treated for 5 years in patients with CHD is 9 for statins, compared with 17.3 for antiplatelet agents. Statins have not yet been shown to reduce stroke risk in the typical general population without known CHD, nor have they been shown to prevent recurrent stroke in patients with prior stroke. Potential reasons for the effects of statins on stroke and the non-cholesterol-lowering mechanisms that may be involved are discussed. Treatment strategies based on global cardiovascular risk may be most effective. Additional studies in patients representative of the typical stroke population are needed. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15198966/Statins_for_stroke_prevention:_disappointment_and_hope_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.CIR.0000131518.25959.8F?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -