Statins have not been shown to prevent recurrent stroke in patients with prior stroke, and additional studies in patients representative of the typical stroke population are needed. In the HPS, the risk of recurrent stroke was 10.3% in the simvastatin group and 10.4% in the placebo group, with a significant heterogeneity (p = 0.002) in the group with no prior cerebrovascular disease at randomization, and there were 21 (1.3%) hemorrhagic strokes in the active group compared with 11 (0.7%) in the placebo group (p = 0.03).[13] The main explanation for this neutral effect was probably owing to the fact that the study was not powered for this comparison, and that patients had their qualifying stroke on average 4.3 months prior to randomization, at a time when the risk of stroke has naturally decreased to its lowest level. By contrast, the risk of MI is continuously increasing over time after a stroke or transient ischemic attack (TIA).
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