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Statins for stroke prevention: disappointment and hope
Pierre Amarenco1, Andrew M Tonkin
1Department 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
Insights
Statins reduce stroke risk in patients with coronary heart disease (CHD), preventing 9 strokes per 1000 patients over 5 years. However, their benefit is not yet proven for the general population or preventing recurrent strokes.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Stroke incidence rises with age, disproportionately affecting the elderly who also have higher coronary heart disease (CHD) risk.
- Cholesterol levels lack a clear association with all stroke causes in epidemiological studies.
- Long-term statin trials demonstrate reduced stroke incidence in patients with established or high-risk CHD.
Purpose of the Study:
- To evaluate the effectiveness of statins in reducing stroke incidence.
- To explore potential non-cholesterol-lowering mechanisms of statins' effect on stroke.
- To assess the role of global cardiovascular risk in treatment strategies.
Main Methods:
- Meta-analysis of 9 large, long-term statin trials involving 70,070 patients.
- Comparison of stroke risk reduction with statins versus antiplatelet agents.
- Review of existing epidemiological and observational data.
Main Results:
- Statins showed a 21% relative and 0.9% absolute risk reduction for stroke in CHD populations.
- 9 strokes per 1000 patients treated with statins for 5 years were prevented in CHD patients.
- Statins did not demonstrate stroke risk reduction in the general population or for preventing recurrent strokes.
Conclusions:
- Statins are effective in reducing stroke incidence in patients with established or high-risk CHD.
- Non-cholesterol-lowering effects may contribute to statins' cerebroprotective benefits.
- Treatment strategies focusing on global cardiovascular risk are recommended; further research in typical stroke populations is needed.
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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