The Case for Statins (with commentary) - 5 COMMENTS ARE WELCOME ON THIS SPECIFIC STUDY

Conclusions, Recommendations, Future Directions

There is persuasive evidence that statins have beneficial effects extending beyond reduction of major coronary event rate and all-cause mortality. Clinical and experimental data show that statins reduce stroke, particularly in patients with established vascular disease and among patients with a high burden of vascular risk factors. Other studies in animal models of stroke suggest that statins may also possess neuroprotective properties that may be important during cerebral ischemia.^[37,38] 

Comments

The preceding comments suggest that lifestyle changes - if consistent and possibly severe - can also do this

The effects of statins on stroke are at variance with epidemiological studies and suggest that statins reduce stroke through cumulative improvements in a number of different components of atherosclerosis including effects on the endothelium, thrombosis, plaque stability, and through anti-inflammatory effects.

More information is needed before statin therapy can be recommended as a specific indication for secondary or primary prevention of stroke.^[6,20]Results of the ongoing Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial^[44] will provide additional information about the role of statins in the minority of patients with prior stroke but no history of coronary heart disease, other occlusive arterial disease, or diabetes. However, considering the discussion above, therapy guided by National Cholesterol Education Program (NCEP) guidelines^[45,46] may have a large impact in stroke reduction. Questions remain as to how low LDL targets should be in specific populations, and the guidelines will probably change as data from large studies such as HPS^[18,21] and ASCOT^[19] are considered. Future studies that look at stroke as a primary end point for statin therapy will further clarify possible expanded indications for statin therapy.

Reprint Address

Address for correspondence: Neil L. Coplan, MD, Cardiology Division, 100 East 77th Street, New York, NY 10021

Prev Cardiol. 2005;8(2):98-101. © 2005 Le Jacq Communications, Inc. 

Nenad Trubelja, MD; Carl Vaughan, MD; Neil L. Coplan, MD

DISCLOSURES 

Prev Cardiol. 2005;8(2):98-101. 

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