on October 28, 2004
Stroke. 2004
Published online before print October 28, 2004, doi: 10.1161/01.STR.0000147965.52712.fa
Published online before print October 28, 2004, doi: 10.1161/01.STR.0000147965.52712.fa
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Submitted on June 18, 2004
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. * To whom correspondence should be addressed. 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.
Revised on August 23, 2004
Accepted on August 31, 2004
Statins in Stroke Prevention and Carotid Atherosclerosis. Systematic Review and Up-to-Date Meta-Analysis
Pierre Amarenco MD*;
Key words: cardiovascular disease • carotid arteries • intima-media thickness • risk • stroke • stroke prevention
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