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Statins and stroke prevention.

Abstract

Over the past decade, statins have been proven to significantly decrease coronary events in primary and secondary prevention of coronary artery disease. Recent clinical trials have indicated that statins significantly reduce stroke risk in patients with vascular disease. The Cholesterol Treatment Trialists' Collaborators in a meta-analysis including 90,056 patients found that the use of statins determined a significant 17% proportional reduction in the incidence of first-ever stroke of any type per 1 mmol/l low-density lipoprotein (LDL) cholesterol reduction. During an average of 5 years of treatment, the reduction in the overall incidence of stroke was about one sixth per 1 mmol/l LDL cholesterol decrease meaning that 8 fewer participants have any stroke per 1,000 among those with preexisting coronary artery disease at baseline, compared with 5 fewer per 1,000 among the participants with no such history. It is not known whether these findings might be due to the cholesterol reduction effect of statins or to pleiotropic effects of statins, such as improved endothelial function, decreased platelet aggregability, and reduced vascular inflammation. In secondary prevention of stroke, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study found that treatment with atorvastatin reduced the risk of recurrent cerebrovascular events in patients with recent stroke or transient ischemic attack but no history of heart disease. Combining the results of patients with no history of heart disease from the SPARCL study and Heart Protection Study in a mini meta-analysis, compared with placebo, statins were associated with a barely nonsignificant difference in recurrent stroke (OR = 0.87, 95% CI = 0.75-1.01, p = 0.07) and a significant difference in the occurrence of major vascular events (OR = 0.78, 95% CI = 0.68-0.88, p = 0.0001) at final follow-up.

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  • Authors+Show Affiliations

    ,

    Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy. maurizio.paciaroni@med.unipg.it

    , ,

    Source

    MeSH

    Atherosclerosis
    Cardiovascular Diseases
    Carotid Arteries
    Cerebral Hemorrhage
    Cholesterol
    Clinical Trials as Topic
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Odds Ratio
    Practice Guidelines as Topic
    Research Design
    Risk Assessment
    Risk Factors
    Secondary Prevention
    Stroke
    Treatment Outcome
    Tunica Intima
    Tunica Media

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    17596685

    Citation

    Paciaroni, Maurizio, et al. "Statins and Stroke Prevention." Cerebrovascular Diseases (Basel, Switzerland), vol. 24, no. 2-3, 2007, pp. 170-82.
    Paciaroni M, Hennerici M, Agnelli G, et al. Statins and stroke prevention. Cerebrovasc Dis. 2007;24(2-3):170-82.
    Paciaroni, M., Hennerici, M., Agnelli, G., & Bogousslavsky, J. (2007). Statins and stroke prevention. Cerebrovascular Diseases (Basel, Switzerland), 24(2-3), pp. 170-82.
    Paciaroni M, et al. Statins and Stroke Prevention. Cerebrovasc Dis. 2007;24(2-3):170-82. PubMed PMID: 17596685.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statins and stroke prevention. AU - Paciaroni,Maurizio, AU - Hennerici,Michael, AU - Agnelli,Giancarlo, AU - Bogousslavsky,Julien, Y1 - 2007/06/27/ PY - 2006/11/30/received PY - 2007/03/25/accepted PY - 2007/6/29/pubmed PY - 2007/10/12/medline PY - 2007/6/29/entrez SP - 170 EP - 82 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc. Dis. VL - 24 IS - 2-3 N2 - Over the past decade, statins have been proven to significantly decrease coronary events in primary and secondary prevention of coronary artery disease. Recent clinical trials have indicated that statins significantly reduce stroke risk in patients with vascular disease. The Cholesterol Treatment Trialists' Collaborators in a meta-analysis including 90,056 patients found that the use of statins determined a significant 17% proportional reduction in the incidence of first-ever stroke of any type per 1 mmol/l low-density lipoprotein (LDL) cholesterol reduction. During an average of 5 years of treatment, the reduction in the overall incidence of stroke was about one sixth per 1 mmol/l LDL cholesterol decrease meaning that 8 fewer participants have any stroke per 1,000 among those with preexisting coronary artery disease at baseline, compared with 5 fewer per 1,000 among the participants with no such history. It is not known whether these findings might be due to the cholesterol reduction effect of statins or to pleiotropic effects of statins, such as improved endothelial function, decreased platelet aggregability, and reduced vascular inflammation. In secondary prevention of stroke, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study found that treatment with atorvastatin reduced the risk of recurrent cerebrovascular events in patients with recent stroke or transient ischemic attack but no history of heart disease. Combining the results of patients with no history of heart disease from the SPARCL study and Heart Protection Study in a mini meta-analysis, compared with placebo, statins were associated with a barely nonsignificant difference in recurrent stroke (OR = 0.87, 95% CI = 0.75-1.01, p = 0.07) and a significant difference in the occurrence of major vascular events (OR = 0.78, 95% CI = 0.68-0.88, p = 0.0001) at final follow-up. SN - 1015-9770 UR - https://www.unboundmedicine.com/medline/citation/17596685/full_citation L2 - https://www.karger.com?DOI=10.1159/000104474 DB - PRIME DP - Unbound Medicine ER -