Statins are effective for primary and tertiary cardiovascular disease prevention. For those with vascular disease or significant risks, statins prevent cerebrovascular accidents and have low adverse event rates.
While no evidence is available about primary prevention of cerebrovascular accidents for those at lower risk, in practice statins are often appropriately initiated. NCEP-ATP III,8 the key guideline on when to start statins, is based more on cardiac benefits.
Most studies evaluating statins use a triple outcome of mortality, myocardial infarction, or cerebrovascular accident.
Since myocardial infarction is more common than the other adverse endpoints, there is a greater demonstrated cardioprotective effect (prevention of myocardial infarction: NNT=95; prevention of cerebrovascular accidents: NNT=735).9
However, regardless of whether the benefits are cardiac or cerebrovascular, statins will prevent disease for many patients.
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