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[Can ischaemic stroke be prevented with statins?]
1Nevrologisk avdeling, Rikshospitalet, 0027 Oslo. arve.dahl@rikshospitalet.no
Insights
Statins (cholesterol-lowering drugs) show a moderate risk reduction for ischaemic stroke in patients with atherosclerotic disease. However, their benefit for secondary stroke prevention in all patients remains unclear due to varied stroke causes.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Context:
- Statins are widely used for cardiovascular disease prevention.
- Ischaemic stroke is a significant cause of morbidity and mortality.
- The role of statins in secondary stroke prevention is under investigation.
Purpose:
- To review the evidence on the association between cholesterol, cerebrovascular disease, and statin use in ischaemic stroke.
- To evaluate the efficacy of statins for secondary stroke prevention.
Summary:
- Cholesterol is a weaker risk factor for ischaemic stroke compared to coronary heart disease, particularly linked to large vessel atherosclerosis.
- Meta-analyses indicate a 20-30% relative risk reduction for ischaemic stroke with statin use in patients with atherosclerotic disease.
- Current evidence does not definitively show reduced risk for new strokes in patients with a previous stroke, nor provide clear guidance for all stroke patients due to diverse stroke mechanisms.
Impact:
- Statins offer a moderate benefit in reducing ischaemic stroke risk for patients with atherosclerosis.
- Further research is needed to clarify the role of statins in secondary stroke prevention, especially in older populations and for non-atherosclerotic stroke types.
Background:
Statins provide a reduction in the risk for ischaemic stroke in patients with coronary artery disease, known atherosclerotic disease, and in patients with risk factors for arterial vascular disease. There is also considerable interest in whether or not statins should be used as a secondary prophylaxis for stroke.
Materials And Method:
This review is based on articles included on Medline that consider the association between cholesterol and cerebrovascular disease and the use of statins in ischaemic stroke.
Results:
Cholesterol is a much weaker risk factor for ischaemic stroke than for coronary heart disease. It is especially associated with thromboembolic stroke due to atherosclerosis of the larger vessels. Meta-analysis of earlier studies in patients with coronary artery disease and several more recent studies which include patients with other atherosclerotic disease and risk factors for atherosclerosis have clearly shown a relative risk reduction for ischaemic stroke of between 20 and 30%. Since these studies were of patients in age groups in which stroke rarely occurs, the relative risk reduction was moderate. Risk reduction seems similar in all age groups with atherosclerotic heart disease and for all cholesterol levels. A reduced risk for a new stroke has to date not been shown for patients with previous stroke.
Conclusion:
Given the fact that stroke is caused by several mechanisms and is often not caused by atherosclerosis of larger vessels, definite advice cannot be given on secondary prevention with statins in all stroke patients. At present there are no results from studies where only ischaemic stroke patients were included and with a sufficient number of older patients.
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