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More Evidence That Statins Cut Stroke Risk
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Data from clinical trials including almost 267,000 participants showed an overall 12 percent reduction in stroke incidence among those taking statins, with each 1 percent reduction in total cholesterol predicting a 0.8 percent relative risk reduction of stroke.
The report, published in the Jan. 19 issue of the Journal of the American College of Cardiology, was led by physicians at G. d'Annunzio University in Chieti, Italy.
"This is consistent with prior studies and reinforces the benefit of statin therapy in preventing stroke in selected populations of patients," said Dr. Larry B. Goldstein, director of the Stroke Center at Duke University.
But the report contains hints that the reduction of stroke risk is not entirely explained by the cholesterol-lowering effect of statins, added Dr. Brendan M. Everett, an instructor in medicine at Harvard Medical School and attending cardiologist at Brigham and Women's Hospital. The JUPITER study, which he helped conduct, found a benefit for people with high levels of C-reactive protein, a marker of inflammation.
"There are many possible explanations for the reduction in stroke risk observed in actively treated patients, and one of those is a reduction of inflammation with statin therapy," Everett said. "In JUPITER, we observed a 48 percent reduction in total stroke and 51 percent reduction in ischemic stroke among patients with a normal LDL cholesterol at baseline."
An ischemic stroke, the most common form, occurs when a blood clot blocks a brain artery.
"We took people with normal cholesterol levels and saw a reduction in stroke similar to that in trials that selected people with higher levels of cholesterol," Everett said. "That suggests to me there's something else going on there."
That's possible, Goldstein said. "In clinical trials you measure LDL cholesterol, but many other things are going on at the same time," he said. "Still, the amount of benefit is directly related to the amount of cholesterol lowering."
While the JUPITER researchers focused on inflammation, "they still reduced LDL cholesterol levels significantly," Goldstein said.
There was no debate about the value of statin therapy in reducing other cardiovascular risks in people with high LDL levels. The Italian analysis found more benefits from statins than from other cholesterol-lowering regimens.
"Statins really ought to be our first choice for cholesterol reduction," Everett said. "That is true for heart disease and true for stroke. We showed that even patients with normal cholesterol levels may benefit from statins."
"The most gratifying thing reported by this meta-analysis is that statins among all lipid-lowering therapies appear to be the most effective," said Dr. Robert D. Brown, chairman of neurology at the Mayo Clinic in Minnesota. "The use of statin therapy is particularly important among people who have had a stroke. They are being used more aggressively in people who have had a stroke in an attempt to prevent another."
At least one trial has shown a significant reduction in second strokes among people taking statins, Brown noted.
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SOURCES: Larry B. Goldstein, M.D., director, Duke Stroke Center, Durham, N.C.; Brendan M. Everett, M.D., instructor, medicine, Harvard Medical School, and attending cardiologist, Brigham and Women's Hospital, Boston; Robert D. Brown, M.D., chairman, neurology, Mayo Clinic, Rochester, Minn; Jan. 11, 2010, Journal of the American College of Cardiology