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(Circulation. 2004;109:III-44 – III-49.)
© 2004 American Heart Association, Inc.

Atherosclerosis: Evolving Vascular Biology and Clinical Implications

Statins for Stroke Prevention

Disappointment and Hope

Pierre Amarenco, MD; Andrew M. Tonkin, MD

From the Department of Neurology and Stroke Center (P.A.), Bichat–Claude Bernard University Hospital and Medical School, Denis Diderot University–Paris VII, and the ‘Formation de Recherche en Neurologie Vasculaire (Association Claude Bernard)’ (P.A.), Paris, France; and NHMRC Clinical Research Centre of Excellence in Therapeutics (A.M.T.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Correspondence to Professor Pierre Amarenco, Department of Neurology and Stroke Center, Bichat University Hospital and Medical School, Denis Diderot University–Paris VII, 46 rue Henri Huchard, 75018 Paris, France. E-mail amarenco{at}ccr.jussieu.fr

The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nonetheless, large, long-term statin trials in patients with established CHD or at high risk for CHD have shown that statins decrease stroke incidence in these populations. Combined data from 9 trials including 70 070 patients indicated relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins. The number of strokes prevented per 1000 patients treated for 5 years in patients with CHD is 9 for statins, compared with 17.3 for antiplatelet agents. Statins have not yet been shown to reduce stroke risk in the typical general population without known CHD, nor have they been shown to prevent recurrent stroke in patients with prior stroke. Potential reasons for the effects of statins on stroke and the non–cholesterol-lowering mechanisms that may be involved are discussed. Treatment strategies based on global cardiovascular risk may be most effective. Additional studies in patients representative of the typical stroke population are needed.

Key Words: cardiovascular risk • prevention • statins • stroke