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Lipids and stroke: neglect of a useful preventive measure?
J A Papadakis1, D P Mikhailidis, A F Winder
1Department of Chemical Pathology and Human Metabolism, Royal Free Hospital and School of Medicine, University of London, UK.
Insights
Statins effectively reduce stroke risk, particularly thrombotic stroke, by lowering serum total cholesterol (TC). Their benefit is most pronounced in patients with established ischemic heart disease (IHD).
Area of Science:
- Cardiovascular Epidemiology
- Neurology
- Pharmacology
Background:
- Epidemiological studies link lipid variables to stroke risk.
- Serum total cholesterol (TC) is positively associated with thrombotic stroke and negatively with hemorrhagic stroke.
- Relationships for other lipid fractions are less defined.
Purpose of the Study:
- To review epidemiological data on lipids and stroke.
- To evaluate the efficacy of lipid-lowering drugs in stroke prevention.
- To discuss mechanisms and the superiority of statins.
Main Methods:
- Review of epidemiological studies on lipid variables and stroke.
- Analysis of results from clinical trials involving lipid-lowering drugs.
- Meta-analysis of statin efficacy in reducing stroke incidence.
Main Results:
- Statins are the only lipid-lowering drugs shown to effectively reduce stroke incidence.
- Statin-induced reduction in TC levels correlates with decreased stroke risk.
- Meta-analyses show significant reduction in thrombotic stroke risk with statins (p < 0.001).
Conclusions:
- Statins offer significant protection against thrombotic stroke, especially in patients with existing ischemic heart disease (IHD).
- The effectiveness of statins may be linked to their impact on TC levels and shared risk factors with IHD.
- Statins can prevent IHD-related events, including mortality, in high-risk patients.
Abstract:
The epidemiological studies linking lipid variables and stroke are reviewed. These studies indicate that serum total cholesterol (TC) levels are associated positively with thrombotic and negatively with haemorrhagic strokes. Relationships for other lipid fractions are not as clearly defined. The results of trials with lipid lowering drugs suggest that only statins effectively reduce the incidence of stroke. Differences between trial results may be due to variation in the extent of reduction of TC levels. Possible underlying mechanisms for benefit and the apparent superiority of statins are also discussed. The reduction in the risk of thrombotic stroke with statins is most evident through meta-analyses (p < 0.001) and less impressive in individual trials (p < 0.03). This difference is largely attributable to the small number of events in trials primarily aimed at evaluating ischaemic heart disease (IHD) reduction. This also means that benefit may be limited to those with established IHD. IHD and thrombotic stroke share common risk factors and patients with one condition are at high risk of developing the other. Therefore, one additional reason for using statins in these patients is that these drugs can effectively prevent IHD-related events including deaths.