[Statins and cerebrovascular events]

PREVENTION AND RISK REDUCTION: Statins consistently have shown an ability to reduce the incidence of ischemic stroke. Two meta-analyses corroborated prospective studies with statins and estimated a 30% risk reduction in stroke which is comparable to stroke reduction noted with aspirin. Stroke rate was evaluated in patients without known coronary artery disease in the West of Scotland Primary Prevention (WOSCOPS) trial. An 11% reduction in stroke was observed in WOSCOPS during 5-year follow-up that did not reach statistical significance (p = 0.57). Documentation of clinical benefit with reductions in stroke and coronary events and long-term safety is available only from statin trials with stroke defined as a secondary end point. The strongest evidence relates to patients with CHD. In this population, statistically highly significant reductions have been reported for stroke, cardiovascular mortality, nonfatal myocardial infarction, all-cause mortality, and need for cardiovascular procedures.

Clinical benefit of statin use for stroke prevention in patients without coronary artery disease is not yet proven. Furthermore, it is unknown whether and to what extent differences in lipid and so-called nonlipid mechanisms, half-life, solubility, potency, and effects on other risk factors influence the clinical efficacy. Future trials will be needed to clarify this issue, particularly in patients with no history of coronary artery disease.