Statin Therapy for Stroke Prevention

BACKGROUND AND PURPOSE: Statins are widely used to reduce the risk of stroke in patients with coronary artery disease (CAD), but less so in patients without CAD. We reviewed recent trials for new evidence for the reduction in risk of stroke. SUMMARY OF REVIEW: In patients with CAD, moderate-intensity statin treatment has been associated with reductions in risk of stroke, with no increase in hemorrhagic stroke. Additionally, in the TNT trial, intensive lipid lowering provided further stroke risk reduction compared with moderate lipid lowering in patients with stable CAD. Evidence is now available that statin therapy also reduces stroke risk in patients without CAD but at high cardiovascular risk, or with diabetes mellitus. The SPARCL trial showed that intensive statin therapy started within 6 months after a cerebrovascular event significantly reduced stroke risk and stroke severity. Low cholesterol levels have been associated with increased risk of hemorrhagic stroke, but although an increased risk of hemorrhagic stroke was observed in patients with prior hemorrhagic stroke in SPARCL, this was not related to low-density lipoprotein cholesterol levels. Clinical trials have recruited few patients with both coronary and cerebrovascular disease, but these patients are also expected to experience significant cardiovascular benefit with statin therapy. CONCLUSIONS: Trial data show that statins reduce the risk of stroke, in addition to providing cardiovascular benefits. Consequently, physicians should consider statin therapy in all patients at high risk of stroke.