Do Statins Prevent Ischemic Stroke?

A meta-analysis supports a role.
Most clinical trials testing the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have focused on their ability to prevent myocardial infarction. Prevention of ischemic stroke was a secondary endpoint, and the numbers of ischemic cerebrovascular events were small. Thus, data about these agents’ ability to prevent stroke are limited. In this manufacturer-funded meta-analysis, the authors carefully examined 42 randomized clinical trials that tested statins against either placebo or no treatment in 121,000 individuals with a range of ischemic vascular diseases. Strict inclusion criteria were used; studies comparing statins were not included.
Data from 11 trials, including 58,604 subjects total, showed that the statins tested reduced the risk for ischemic cerebrovascular events (relative risk, 0.81; 95% confidence interval, 0.69–0.94). Data from another 11 trials with 54,334 subjects showed that statins did not significantly increase the frequency of hemorrhagic strokes, although the confidence intervals were broad. Statins had no impact on mortality from stroke but reduced all-cause mortality (RR, 0.88; 95% CI, 0.83–0.93).
Comment: Aggressive management of hyperlipidemia is standard care for patients with atherosclerotic coronary artery disease, but the role of such treatment in preventing stroke is less obvious. These meta-analysis results buttress those of the recently published SPARCL study, which tested the utility of atorvastatin in preventing recurrent stroke (N Engl J Med 2006; 355:549). The current results confirm that statins are useful in lowering the risk for ischemic stroke among patients with atherosclerotic disease. Although SPARCL raised the concern that aggressive lowering of lipid levels might increase hemorrhagic stroke risk, the current results do not provide evidence of a strong link between the use of statins and the risk for cerebral hemorrhage. Overall, the benefit of statins in preventing ischemic events outweighs the risk for bleeding complications.
— Harold P. Adams, Jr., MD
Dr. Adams is Professor, Department of Neurology, University of Iowa College of Medicine, Iowa City.
Published in Journal Watch Neurology March 4, 2008
Citation(s):
O’Regan C et al. Statin therapy in stroke prevention: A meta-analysis involving 121,000 patients. Am J Med 2008 Jan; 121:24.