Tags

Type your tag names separated by a space and hit enter

Effect of statins in stroke prevention.

Abstract

PURPOSE OF REVIEW

This paper reviews recent studies into the outcomes of clinical trials in which statin therapy has been used in the prevention and treatment of strokes.

RECENT DEVELOPMENTS

Epidemiologic studies found no or little association between blood cholesterol levels and stroke. Randomized trials have confirmed that LDL lowering decreased the risk of stroke, in diabetic or hypertensive patients with 'normal' LDL cholesterol at baseline, and in patients with coronary artery disease, with respectively 48, 27 and 25% reduction in stroke incidence. A meta-analysis of trials showed that the greater the LDL cholesterol reduction, the greater the intima-media thickness and stroke risk reductions. Even if statins also have 'pleiotropic' effects, their main action seems to be through LDL reduction. The Heart Protection Study only included strokes that occurred 4.6 years before--a time when the stroke event rate is low and the cardiac event rate is high, and so may not have had the power to find a true effect of LDL cholesterol lowering in preventing recurrent stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial may give a definite answer because SPARCL investigators included 4732 patients with brain infarction or transient ischemic attacks and no history of myocardial infarction within 6 months of their stroke event, at a time when the expected stroke rate is very high and the myocardial infarction rate is very low. The results should be announced by mid-2006.

SUMMARY

The positive effect of statins on stroke observed in trials of patients with coronary heart disease depended mainly on between-group LDL reduction, but other mechanisms could be involved. Though effective in prevention of major coronary events after a first stroke, statins have not yet been proven effective in prevention of recurrent stroke.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Neurology and Stroke Centre, Bichat University Hospital, Denis Diderot University and Medical School, Paris, France. amarenco@ccr.jussieu.fr

    Source

    Current opinion in lipidology 16:6 2005 Dec pg 614-8

    MeSH

    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Prospective Studies
    Randomized Controlled Trials as Topic
    Recurrence
    Stroke

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16276237

    Citation

    Amarenco, Pierre. "Effect of Statins in Stroke Prevention." Current Opinion in Lipidology, vol. 16, no. 6, 2005, pp. 614-8.
    Amarenco P. Effect of statins in stroke prevention. Curr Opin Lipidol. 2005;16(6):614-8.
    Amarenco, P. (2005). Effect of statins in stroke prevention. Current Opinion in Lipidology, 16(6), pp. 614-8.
    Amarenco P. Effect of Statins in Stroke Prevention. Curr Opin Lipidol. 2005;16(6):614-8. PubMed PMID: 16276237.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of statins in stroke prevention. A1 - Amarenco,Pierre, PY - 2005/11/9/pubmed PY - 2008/8/22/medline PY - 2005/11/9/entrez SP - 614 EP - 8 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 16 IS - 6 N2 - PURPOSE OF REVIEW: This paper reviews recent studies into the outcomes of clinical trials in which statin therapy has been used in the prevention and treatment of strokes. RECENT DEVELOPMENTS: Epidemiologic studies found no or little association between blood cholesterol levels and stroke. Randomized trials have confirmed that LDL lowering decreased the risk of stroke, in diabetic or hypertensive patients with 'normal' LDL cholesterol at baseline, and in patients with coronary artery disease, with respectively 48, 27 and 25% reduction in stroke incidence. A meta-analysis of trials showed that the greater the LDL cholesterol reduction, the greater the intima-media thickness and stroke risk reductions. Even if statins also have 'pleiotropic' effects, their main action seems to be through LDL reduction. The Heart Protection Study only included strokes that occurred 4.6 years before--a time when the stroke event rate is low and the cardiac event rate is high, and so may not have had the power to find a true effect of LDL cholesterol lowering in preventing recurrent stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial may give a definite answer because SPARCL investigators included 4732 patients with brain infarction or transient ischemic attacks and no history of myocardial infarction within 6 months of their stroke event, at a time when the expected stroke rate is very high and the myocardial infarction rate is very low. The results should be announced by mid-2006. SUMMARY: The positive effect of statins on stroke observed in trials of patients with coronary heart disease depended mainly on between-group LDL reduction, but other mechanisms could be involved. Though effective in prevention of major coronary events after a first stroke, statins have not yet been proven effective in prevention of recurrent stroke. SN - 0957-9672 UR - https://www.unboundmedicine.com/medline/citation/16276237/Effect_of_statins_in_stroke_prevention_ L2 - http://Insights.ovid.com/pubmed?pmid=16276237 DB - PRIME DP - Unbound Medicine ER -