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(Stroke. 2006;37:294.)
© 2006 American Heart Association, Inc.

Advances in Stroke 2005

The Dynamics of Statins

From Event Prevention to Neuroprotection

From the Department of Neurology and Stroke Centre (P.A.), Denis Diderot University and Medical School, Bichat Hospital, Paris, France; and the Stroke and Neurovascular Regulation Laboratory (M.A.M.), Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass.

Correspondence to Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France. E-mail pierre.amarenco@bch.aphp.fr

Key Words: prevention & control • statins, HMG-CoA

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

Working on new antibiotic candidates, Akira Endo found in 1976 that statins could strongly inhibit HMG-CoA reductase.¹ It turned out that his discovery was the most important advance in cardiovascular prevention since aspirin and blood pressure–lowering. Contradicting most epidemiological studies which failed to find a link between cholesterol levels and stroke,² statins strongly reduce stroke incidence. This prompted an investigation of the non–cholesterol-dependent effects of statins, so called pleiotropic effects, on biologic actions related to plaque instability, inflammation, endothelial function, fibrinolytic activity, platelet function,³ as well as cerebral blood flow and NO-enhancing pathways leading to neuroprotection.

Low-Density Lipoprotein Reduction as an Essential Biological Marker of Stroke Risk

Since the publication of the Scandinavian Simvastatin Survival Study (4S),⁴ the majority of statin trials found a significant reduction in stroke events in patients with coronary heart disease, or with a history of vascular disease, high blood pressure or diabetes. The meta-analysis of over 90 000 patients showed a significant 21% stroke reduction with no statistical heterogeneity between trials and no increase in hemorrhagic stroke.⁵ Indeed, from the meta-analysis, low-density lipoprotein (LDL) reduction could be related to 35% to 80% of the statin benefit.⁵ New results from randomized trials confirmed that LDL-lowering was associated with a decreased risk of stroke by 48% in diabetics with "normal" LDL cholesterol at baseline,⁶ and 25% in patients with coronary artery disease.⁷ In the Treat to New Target trial, the benefit was observed in patients with a mean LDL cholesterol of 70 mg/dL as compared with the group of patients with a mean LDL level of 1.02 mg/dL.⁷ . . . [Full Text of this Article]

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