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(Stroke. 2003;34:351.)
© 2003 American Heart Association, Inc.

Advances in Stroke 2002

Statins in Threatened Stroke

Markku Kaste, MD

From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.

Correspondence to Markku Kaste, Helsinki University Central Hospital, Department of Neurology, PO Box 340, FIN-00029 HUS, Finland. E-mail markku.kaste@hus.fi

Key Words: hemorrhagic stroke • ischemic stroke • prevention • statins • vascular dementia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

What Is Known: Statins in Stroke Prevention

Both a meta-analysis¹ and the large secondary prevention trials of coronary heart disease (CHD) with simvastatin² and with pravastatin^3,4 revealed a reduction of 19% to 32% in ischemic strokes in patients with CHD. The results led to the Food and Drug Administration approval of pravastatin and simvastatin for stroke prevention in patients with CHD. Accordingly, patients with atherosclerotic stroke are candidates for lipid-lowering therapy, although before the Heart Protection Study (HPS), no randomized trials of cholesterol-lowering therapy in patients with transient ischemic attack (TIA) or stroke had verified the benefits of statins in stroke prevention in these high-risk patients without diagnosed CHD.⁵ The HPS enrolled 1821 patients with TIA or stroke but without CHD and altogether 3280 TIA or stroke patients with or without CHD. The results of the study helped resolve most of the still-remaining uncertainties.⁵

HPS

Study Design
To ensure the compliance, potentially eligible people entered a prerandomization run-in phase, which involved 4 weeks of placebo followed by 4 to 6 weeks of a fixed dose of 40 mg simvastatin daily to allow assessment of responsiveness of each individual. A central telephone randomization system was used to balance the treatment groups with respect to eligibility criteria and other major prognostic factors.

Study Population
Men and women aged 40 to 80 years with nonfasting blood total cholesterol concentrations of at least 135 mg/dL (3.5 mmol/L) were eligible provided that they were considered to be at substantial 5-year risk of death from CHD because of past history of CHD, occlusive disease of noncoronary arteries, ie, . . . [Full Text of this Article]

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