Statins and stroke prevention

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  • P. L
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Abstract

Four randomized trials with a statin and one trial with a fibrate showed a modest but significant absolute reduction in the incidence of stroke in patients with a previous myocardial infarction. The reasons for the positive effect of statins on stroke end-point are unclear since, paradoxically, the link between serum cholesterol level and stroke has never been fully established. Furthermore, the positive results of statins trials were mainly obtained in patients with an average or a low serum cholesterol level. This suggests nonhypolipidemic effects of these drugs, so-called pleiotropic effects, acting on the biologic promoters of plaque instability. Statins have a good overall safety profile with no increase of hemorrhagic stroke and no increase in cancer. They have positive effects in primary prevention of cardiovascular disease in high-risk young as well as elderly populations. Statins reduced stroke incidence in high-risk (mainly CHD, diabetics and hypertensives) population even with a normal baseline blood cholesterol level, which argues for a global cardiovascular risk-based treatment strategy. In patients with prior strokes, statins likely reduce the incidence of cononary events, but it is not yet proven that statins actually reduce the incidence of recurrent strokes in secondary prevention. If current hypotheses are verified by ongoing trials, we may expect between 20 to 30 more stroke events avoided per 1,000 patients treated during 2 years with a lipid-lowering agent, which adds to the 28 stroke events prevented with an antiplatelet agent over the same time period. This would be one of the most significant advances in stroke and vascular dementia prevention since the era of aspirin therapy. Copyright © 2004 S. Karger AG, Basel.

Author-supplied keywords

  • *atorvastatin/cm [Drug Comparison]
  • *atorvastatin/ct [Clinical Trial]
  • *atorvastatin/dt [Drug Therapy]
  • *atorvastatin/pd [Pharmacology]
  • *cerebrovascular accident/dt [Drug Therapy]
  • *cerebrovascular accident/ep [Epidemiology]
  • *cerebrovascular accident/pc [Prevention]
  • *pravastatin/ae [Adverse Drug Reaction]
  • *pravastatin/cm [Drug Comparison]
  • *pravastatin/ct [Clinical Trial]
  • *pravastatin/dt [Drug Therapy]
  • *pravastatin/pd [Pharmacology]
  • *simvastatin/ae [Adverse Drug Reaction]
  • *simvastatin/ct [Clinical Trial]
  • *simvastatin/dt [Drug Therapy]
  • *simvastatin/pd [Pharmacology]
  • acetylsalicylic acid/cb [Drug Combination]
  • acetylsalicylic acid/dt [Drug Therapy]
  • age distribution
  • amlodipine/cb [Drug Combination]
  • amlodipine/dt [Drug Therapy]
  • antihypertensive agent/cm [Drug Comparison]
  • antihypertensive agent/dt [Drug Therapy]
  • antihypertensive agent/pd [Pharmacology]
  • antilipemic agent/ae [Adverse Drug Reaction]
  • antilipemic agent/ct [Clinical Trial]
  • antilipemic agent/dt [Drug Therapy]
  • antilipemic agent/pd [Pharmacology]
  • antithrombocytic agent/cm [Drug Comparison]
  • antithrombocytic agent/dt [Drug Therapy]
  • atherosclerotic plaque/dt [Drug Therapy]
  • beta adrenergic receptor blocking agent/cb [Drug C
  • beta adrenergic receptor blocking agent/dt [Drug T
  • brain hemorrhage/si [Side Effect]
  • cancer/si [Side Effect]
  • cardiovascular disease
  • cardiovascular risk
  • carotid artery obstruction/dt [Drug Therapy]
  • cholesterol blood level
  • clinical trial
  • conference paper
  • congestive cardiomyopathy
  • diabetes mellitus
  • dipeptidyl carboxypeptidase inhibitor/cb [Drug Com
  • dipeptidyl carboxypeptidase inhibitor/dt [Drug The
  • diuretic agent/cb [Drug Combination]
  • diuretic agent/dt [Drug Therapy]
  • drug effect
  • drug efficacy
  • drug mechanism
  • drug safety
  • endothelial nitric oxide synthase/ec [Endogenous C
  • heart infarction
  • high risk population
  • human
  • hypertension/dt [Drug Therapy]
  • meta analysis
  • myalgia/si [Side Effect]
  • neuroprotection
  • neuroprotective agent/ae [Adverse Drug Reaction]
  • neuroprotective agent/ct [Clinical Trial]
  • neuroprotective agent/dt [Drug Therapy]
  • neuroprotective agent/pd [Pharmacology]
  • pleiotropy
  • polyneuropathy/si [Side Effect]
  • priority journal
  • promoter region
  • rhabdomyolysis/si [Side Effect]
  • sibrafiban/cm [Drug Comparison]
  • sibrafiban/dt [Drug Therapy]
  • thrombogenesis
  • upregulation

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Authors

  • Amarenco P.

  • Lavallee P.

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