Statins in Stroke Prevention and Carotid Atherosclerosis
Top Cited Papers
- 1 December 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 35 (12), 2902-2909
- https://doi.org/10.1161/01.str.0000147965.52712.fa
Abstract
Background and Purpose— Previously published meta-analyses exploring the effect of statins on stroke incidence included 20 000 patients and found a 2% to 30% risk reduction. It is not clear whether this is attributable to low-density lipoprotein–cholesterol (LDL-C) reduction. Statin trials have now included >90 000 patients. We have determined the effect of statins and LDL-C reduction on stroke prevention Summary of Review— We performed a systematic review and meta-analysis of all randomized trials testing statin drugs published before August 2003. The trials were identified using a computerized PubMed search. We analyzed separately statin effect on incident strokes and on carotid intima-media thickness (IMT) according to LDL-C reduction. The relative risk reduction for stroke was 21% (odds ratio [OR], 0.79 [0.73 to 0.85]), with no heterogeneity between trials. Fatal strokes were reduced but not significantly: by 9% (OR, 0.91 [0.76 to 1.10]). There was no increase in hemorrhagic strokes (OR, 0.90 [0.65 to 1.22]). Statin size effect was closely associated with LDL-C reduction. Each 10% reduction in LDL-C was estimated to reduce the risk of all strokes by 15.6% (95% CI, 6.7 to 23.6) and carotid IMT by 0.73% per year (95% CI, 0.27 to 1.19). Conclusions— Statins may reduce the incidence of all strokes without any increase in hemorrhagic strokes, and this effect is mainly driven by the extent of between-group LDL-C reduction. Carotid IMT progression also strongly correlated with LDL-C reduction.Keywords
This publication has 42 references indexed in Scilit:
- Design and Baseline Characteristics of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) StudyCerebrovascular Diseases, 2003
- Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs Usual Care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)JAMA, 2002
- Low Concentration of Serum Total Cholesterol Is Associated With Multifocal Signal Loss Lesions on Gradient-Echo Magnetic Resonance ImagingStroke, 2002
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trialThe Lancet, 2002
- Prevention of Cardiovascular Events and Death with Pravastatin in Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol LevelsThe New England Journal of Medicine, 1998
- Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II)The American Journal of Cardiology, 1995
- Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen city heart studyBMJ, 1994
- Baseline characteristics of subjects in the lipoprotein and coronary atherosclerosis study (LCAS) with fluvastatinThe American Journal of Cardiology, 1994
- Effects of pravastatin in patients with serum total cholesterol levels from 5.2 to 7.8 mmol/liter (200 to 300 mg/dl) plus two additional atherosclerotic risk factorsThe American Journal of Cardiology, 1993
- Serum Cholesterol Levels and Six-Year Mortality from Stroke in 350,977 Men Screened for the Multiple Risk Factor Intervention TrialThe New England Journal of Medicine, 1989