Statin treatment and cerebrovascular disease

In patients with cardiovascular risk factors the use of a statin reduces the risk of stroke.

• statin treatment taken for up to about 5 years appears to reduce the risk of stroke by 19-32% in patients with or without evidence of coronary heart disease (1,2,3,4,5)
• a more recent meta-analysis concluded that statins reduce stroke; the incidence of fatal strokes was reduced but not significantly in this meta-analysis (6). Statins do not increase haemorrhagic stroke. The degree of stroke reduction is correlated with low density lipoprotein cholesterol 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)

Reference:

1. Scandinavian Simvastatin Survival Study Group (1994). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Study (4S). Lancet; 344: 1383-9.
2. Sacks FM et al (1996). The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. NEJM; 335: 1001-9.
3. Long-term intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group (1998). Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. NEJM; 339: 1349-57.
4. Plehn JF et al (1999). Reduction of stroke incidence after myocardial infarction with pravastatin. The cholesterol and recurrent events (CARE) study. Circulation; 99: 216-23.
5. Herbert PR et al (1997). Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA; 278: 313-21.
6. Amarenco P et a (2004). Statins in stroke prevention and carotid atherosclerosis: a systematic review and up-to-date meta-analysis. Stroke; 35:2902-9