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(Stroke. 2004;35:2902.)
© 2004 American Heart Association, Inc.

Progress Review

Statins in Stroke Prevention and Carotid Atherosclerosis

Systematic Review and Up-to-Date Meta-Analysis

From the Department of Neurology and Stroke Centre, Bichat, Claude Bernard University Hospital and Medical School, Denis Diderot University, Paris VII, Assistance Publique-Hôpitaux de Paris and "Formation de Recherche en Neurologie Vasculaire (Association Claude Bernard)," Paris, France.

Correspondence to Professor Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat University Hospital and Medical School, Denis Diderot University –Paris VII, 46 rue Henri Huchard, 75018 Paris, France. E-mail amarenco{at}ccr.jussieu.fr

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.

Key Words: cardiovascular disease • carotid arteries • intima-media thickness • risk • stroke • stroke prevention

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