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Reductase inhibitor monotherapy and stroke prevention
J R Crouse1, R P Byington, H M Hoen
1Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC, USA.
Archives of Internal Medicine
|June 23, 1997
Summary
Newer cholesterol-lowering drugs, reductase inhibitors, significantly reduce stroke events. This meta-analysis confirms their effectiveness, particularly in secondary prevention for coronary heart disease patients.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Previous analyses suggested cholesterol reduction did not impact stroke events.
- These earlier studies excluded recent trials with reductase inhibitors.
Purpose of the Study:
- To meta-analyze the effect of cholesterol reduction on stroke incidence.
- Included primary and secondary coronary heart disease prevention trials using reductase inhibitor monotherapy.
Main Methods:
- Meta-analysis of 12 reported clinical trials (4 primary, 8 secondary prevention).
- Focused on trials using reductase inhibitor monotherapy with incident stroke data.
Main Results:
- Combined analysis showed a 27% statistically significant reduction in stroke (P = .001) with reductase inhibitors.
- Secondary prevention trials demonstrated a 32% stroke reduction (P = .001).
- Primary prevention trials showed a nonsignificant 15% stroke reduction (P = .48).
Conclusions:
- Reductase inhibitors are potent, well-tolerated agents that reduce stroke.
- The most notable stroke reduction was observed in patients with existing coronary artery disease.
- Potential mechanisms include effects on carotid atherosclerosis and reduced coronary heart disease events.