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| John R. Crouse III,
MD |
A growing consensus that statin treatment reduces risk for
stroke in secondary prevention has been developing over the
past 2 years. This consensus is particularly noteworthy considering
that prior to a few years ago, people felt there was no relation
between cholesterol and stroke. A more recent meta-analysis
(Arch Intern Med. 1997;157:1305-1310), which included
the 4S and CARE studies, shows that statin treatment does
reduce stroke. Additionally, the recently reported LIPID study
confirms these data on secondary prevention and stroke reduction.
The effects seem to be most dramatic in individuals who have
had a prior MI. This information has been recently incorporated
into the Consensus Statement guidelines issued by the National
Stroke Association (JAMA. 1999;281:1112-1120). For
the first time, the neurology community states: “Current
evidence suggests that cholesterol-lowering agents, in particular
the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors
(statin agents), decrease the risk of stroke after MI.”
The mechanism whereby cholesterol lowering reduces risk for
stroke in these trials is still unclear and very possibly
multifactorial. Cholesterol reduction is known to retard the
progression of carotid atherosclerosis and to improve vascular
function. Statins may also have effects related to thrombosis
and/or nitric oxide-mediated functions that are independent
of their effect on LDL-C reduction. Finally, cholesterol lowering
may reduce the incidence of stroke as a consequence of reducing
the incidence of heart attack, an effect strongly associated
with treatment with pravastatin, simvastatin, and lovastatin.
John R. Crouse III, MD
Professor of Medicine and Public Health Sciences
Wake Forest School of Medicine
Winston-Salem, North Carolina
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