Do statins reduce the incidence of stroke and carotid IMT progression?
Statins significantly reduce the incidence of all strokes and carotid IMT progression, with the benefit primarily driven by the extent of LDL-C reduction.
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.
Amarenco et al. (2004) studied this question.
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